Many methadone maintenance clients are required to visit a clinic daily, so treatment attendance is essential for clients' compliance and treatment effectiveness. Using data derived from a unique ...survey, this study provides evidence of economic barriers to regular treatment attendance. Hypotheses tested are (1) higher personal costs reduce treatment attendance, and (2) willingness to pay (WTP) provides better time price estimates than wage rates. The findings suggest that both time and money function as rationing devices for methadone maintenance clients. The study finds WTP preferable to wage rate in measuring time price as evaluated by the effects of time price on treatment attendance.
Long-term alcoholism treatment costs Goodman, A C; Nishiura, E; Hankin, J R ...
Medical care research and review,
12/1996, Letnik:
53, Številka:
4
Journal Article
Recenzirano
Examines the efficient provision of alcoholism treatment by determining how several factors predict long-term alcoholism treatment costs, drawing on an integrated analysis of 1980-1987 health ...insurance claims data from 791 employees or retirees of a midwestern manufacturing company that considers the decision to seek alcoholism treatment, treatment location (inpatient or outpatient), & treatment costs conditional on treatment location. It is found that the probability of long-term treatment depends on whether a comorbidity is present. Comorbidities have an impact on long-term costs by affecting where treatment occurs. Increased short-term treatment has a small negative effect on long-term costs for patients with dependence & a negligible effect on abusers. Most of the treatment costs, however, occur in the short term. 7 Tables, 1 Figure, 1 Appendix, 42 References. Adapted from the source document.
BACKGROUND: Health services researchers have increasingly used hazard functions to examine illness or treatment episode lengths and related treatment utilization and treatment costs. There has been ...little systematic hazard analysis, however, of mental health/substance abuse (MH/SA) treatment episodes. AIMS OF THE STUDY: This article uses proportional hazard functions to characterize multiple treatment episodes for a sample of insured clients with at least one alcohol or drug treatment diagnosis over a three-year period. It addresses the lengths and timing of treatment episodes, and the relationships of episode lengths to the types and locations of earlier episodes. It also identifies a problem that occurs when a portion of the sample observations is ǣpossibly censored. Failure to account for sample censoring will generate biased hazard function estimates, but treating all potentially censored observations as censored will overcompensate for the censoring bias. METHODS: Using insurance claims data, the analysis defines health care treatment episodes as all events that follow the initial event irrespective of diagnosis, so long as the events are not separated by more than 30 days. The distribution of observations ranges from 1 day to 3 years, and individuals have up to 10 episodes. Due to the data collection process, observations may be right censored if the episode is either ongoing at the time that data collection starts, or when the data collection effort ends. The Andersen-Gill (AG) and Wei-Lin-Weissfeld (WLW) estimation methods are used to address relationships among individuals multiple episodes. These methods are then augmented by a probit censoring model that estimates censoring probability and adjusts estimated behavioral coefficients and related treatment utilization and treatment costs. There has been little systematic hazard analysis, however, of mental health/substance abuse (MH/SA) treatment episodes. RESULTS: Five sets of variables explain episode duration: (i) individual; (ii) insurance; (iii) employer; (iv) binary, indicating episode diagnosis, location, and sequence; and (v) linkage, relating current diagnoses to previous diagnoses in a sequence. Sociodemographic variables such as age or gender have impacts at both the individual and at the firm level. Coinsurance rates and deductibles also have impacts at the individual and the firm levels. Binary variables indicate that surgical/outpatient episodes were the shortest, and psychiatric/outpatient episodes were the longest. Linkage variables reveal significant impacts of prior alcoholism, drug, and psychiatric episodes on the lengths of subsequent episodes. DISCUSSION: Health care treatment episodes are linked to each other both by diagnosis and by treatment location. Both the AG and the WLW models have merit for treating multiple episodes. The AG model permits more flexibility in estimating hazards, and allows researchers to model impacts of prior diagnoses on future episodes. The WLW model provides a convenient way to examine impacts of sociodemographic variables across episodes. It also provides efficient pooled estimates of coefficients and their standard errors. LIMITATIONS: The insurance claims data set covers 1989 through 1991, predating current managed care plans. It cannot identify untreated substance abusers, nor can it identify those with out-of-plan use. It provides treatment information only if services are covered by the insurance plan and are defined with a substance abuse diagnosis code. Like medical records, insurance claims will not specify substance abuse treatment received within the context of other health care (and thus identified by a non-substance abuse diagnosis code) or community services. IMPLICATIONS FOR POLICY AND RESEARCH: This article characterizes multiple health treatment episodes for a sample of insured clients with at least one alcohol or drug treatment diagnosis within a three-year period. We identify both individual and employer effects on episode length. We find that episode lengths vary by the diagnosis type, and that the lengths (and by inference cost and utilization) may depend on the treatments that occurred in previous episodes. We also recognize that health care or illness episodes may be ongoing at times of health care events prior to the ends of data collection periods, leading to uncertain episode lengths. Corresponding estimates of costs or utilization are also uncertain. We provide a method that adjusts the episode lengths according to the probability of censoring.
This paper models, as equilibrium behavior, buyers' behaviors under transactions costs and market failure constraints. It derives equilibrium conditions and it shows how they differ from ...unconstrained models. Standard utility and cost parameters are then used to estimate the economic costs of the constraints, which may be interpreted, at the margin, as the transactions costs of moving. If transactions costs are greater than the economic costs of the constraints, the household remains in a residence, even in response to changed price and income expectations. Changes in expected prices and incomes lead to changed housing demand even when the household cannot adjust housing consumption between periods. These findings have implications for empirical work with both cross‐section and panel data sets.
Has drinking by pregnant women decreased since the implementation of the alcoholic beverage warning label? The authors examined the reported drinking of 4397 pregnant black women who sought prenatal ...care in an inner city clinic of Detroit, MI. They found that the warning label had a differential effect on risk drinkers (women consuming at least .5 ounce of absolute alcohol per day at conception) and lighter drinkers/abstainers (women consuming less than .5 ounce of absolute alcohol per day at conception). Six months after the warning label law was implemented (June 1, 1990), lighter drinkers decreased their drinking during pregnancy by a small but statistically significant amount. In contrast, pregnant risk drinkers did not significantly change their alcohol consumption.
