Journal of Mental Health Policy and Economics最新文献

{"title":"Empirical evidence on the demand for carve-outs in employment group mental health coverage","authors":"David S. Salkever,&nbsp;Judith A. Shinogle","doi":"10.1002/1099-176X(200006)3:2<83::AID-MHP81>3.0.CO;2-F","DOIUrl":"https://doi.org/10.1002/1099-176X(200006)3:2<83::AID-MHP81>3.0.CO;2-F","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; &lt;b&gt;Background and Aims of Study&lt;/b&gt;:&lt;/h3&gt;\u0000 \u0000 &lt;p&gt; The use of specialized behavioral health companies to manage mental/health benefits has become widespread in recent years. Recent studies have reported on the cost and utilization impacts of behavioral health carve-outs. Yet little previous research has examined the factors which lead employer-based health plans to adopt a carve-out strategy for mental health benefits. The examination of these factors is the main focus of our study. Our empirical analysis is also intended to explore several hypotheses (moral hazard, adverse selection, economies of scale and alternate utilization management strategies) that have recently been advanced to explain the popularity of carve-outs.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; &lt;b&gt;Methods&lt;/b&gt;:&lt;/h3&gt;\u0000 \u0000 &lt;p&gt; The data for this study are from a survey of employers who have long-term disability contracts with one large insurer. The analysis uses data from 248 employers who offer mental health benefits combined with local market information (e.g. health care price proxies, state tax rates etc), state regulations (mental health and substance abuse mandate and parity laws) and employee characteristics. Two different measures of carve-out use were used as dependent variables in the analysis: (1) the fraction of health plans offered by the employer that contained carve-out provisions and (2) a dichotomous indicator for those employers who included a carve-out arrangement in all the health plans they offered.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; &lt;b&gt;Results&lt;/b&gt;:&lt;/h3&gt;\u0000 \u0000 &lt;p&gt; Our results tended to support the general cost-control hypothesis that factors associated with higher use and/or costs of mental health services increase the demand for carve-outs. Our results gave less consistent support to the argument that carve-outs are demanded to control adverse selection, though only a few variables provided a direct test of this hypothesis. The role of economies of scale (i.e., group size) and the effectiveness of alternative strategies for managing moral hazard costs (i.e., HMOs) were confirmed by our results.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; &lt;b&gt;Discussion&lt;/b&gt;:&lt;/h3&gt;\u0000 \u0000 &lt;p&gt; We considered a number of different hypotheses concerning employers' demands for mental health carve-outs and found varying degrees of support for these hypotheses in our data. Our results tended to support the general cost-control hypothesis that factors associated with higher use and/or costs of mental health services increase the demand for carve-outs.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; &lt;b&gt;Limitations&lt;/b&gt;:&lt;/h3&gt;\u0000 \u0000 &lt;p&gt; Our ","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"3 2","pages":"83-95"},"PeriodicalIF":1.6,"publicationDate":"2000-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/1099-176X(200006)3:2<83::AID-MHP81>3.0.CO;2-F","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72127422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Big studies, simple lessons","authors":"Susan M. Essock","doi":"10.1002/1099-176X(200006)3:2<111::AID-MHP80>3.0.CO;2-X","DOIUrl":"https://doi.org/10.1002/1099-176X(200006)3:2<111::AID-MHP80>3.0.CO;2-X","url":null,"abstract":"<p>Goldman describes how service systems research examines the impact of economic and organizational strategies designed to promote particular service combinations (such as continuity of care) and inhibit others (such as preferentially serving only those individuals who are the easiest to treat). The recurring theme from the large services research initiatives is that the content of care, as well as the organization and financing of care, matters. This theme is distinct from what these large services research projects were designed to assess, which speaks both to the unexpected benefits from these massive studies and the need for more efficient tools to examine the interrelationships among the organization, financing and content of care.</p>","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"3 2","pages":"111-112"},"PeriodicalIF":1.6,"publicationDate":"2000-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/1099-176X(200006)3:2<111::AID-MHP80>3.0.CO;2-X","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72162498","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The interdependence of mental health service systems: the effects of VA mental health funding on veterans' use of state mental health inpatient facilities","authors":"Rani A. Desai,&nbsp;Robert A. Rosenheck","doi":"10.1002/1099-176X(200006)3:2<61::AID-MHP74>3.0.CO;2-F","DOIUrl":"https://doi.org/10.1002/1099-176X(200006)3:2<61::AID-MHP74>3.0.CO;2-F","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; &lt;b&gt;Background:&lt;/b&gt;&lt;/h3&gt;\u0000 \u0000 &lt;p&gt; There are relatively few published data on how the financial structures of different health systems affect each other. With increasing financial restrictions in both public and private healthcare systems, it is important to understand how changes in one system (e.g. VA mental healthcare) affect utilization of other systems (e.g. state hospitals).&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; &lt;b&gt;Aims of Study:&lt;/b&gt;&lt;/h3&gt;\u0000 \u0000 &lt;p&gt; This study utilizes data from state hospitals in eight states to examine the relationship of VA &lt;i&gt;per capita&lt;/i&gt; mental health funding and state &lt;i&gt;per capita&lt;/i&gt; mental health expenditures to veterans' use of state hospitals, adjusting for other determinants of utilization.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; &lt;b&gt;Methods:&lt;/b&gt;&lt;/h3&gt;\u0000 \u0000 &lt;p&gt; This study utilized a large database that included records from all male inpatient admissions to state hospitals between 1984 and 1989 in eight states (&lt;i&gt;n&lt;/i&gt; = 152541). Funding levels for state hospitals and VA mental health systems were examined as alternative enabling factors for veterans' use of state hospital care. Logistic regression models were adjusted for other determinants of utilization such as socio-economic status, diagnosis, travel distances to VA and non-VA facilities and the proportion of veterans in the population.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; &lt;b&gt;Results:&lt;/b&gt;&lt;/h3&gt;\u0000 \u0000 &lt;p&gt; The single strongest predictor of whether a state hospital patient would be a veteran was the level of VA mental healthcare funding (OR = 0.81 per $10 of funding per veteran in the population, &lt;i&gt;p&lt;/i&gt; = 0.0001), with higher VA funding associated with less use of state hospitals by veterans. Higher &lt;i&gt;per capita&lt;/i&gt; state funding, reciprocally, increased veterans' use of state hospitals. We also calculated elasticities for state hospital use with respect to VA mental healthcare funding and with respect to state hospital &lt;i&gt;per capita&lt;/i&gt; funding. A 50% increase in VA &lt;i&gt;per capita&lt;/i&gt; mental health spending was associated with a 30% decrease in veterans' use of state hospitals (elasticity of −0.6). Conversely, a 50% increase in state hospital &lt;i&gt;per capita&lt;/i&gt; funding was associated with only an 11% increase in veterans' use of state hospitals (elasticity of 0.06).&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; &lt;b&gt;Implications for Health Care Provision and Use:&lt;/b&gt;&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;These data indicate that &lt;i&gt;per capita&lt;/i&gt; funding for state hospitals and VA mental health systems exerts a significant influence on service use, apparently mediated by the effect on supply of mental health services. Veterans are","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"3 2","pages":"61-67"},"PeriodicalIF":1.6,"publicationDate":"2000-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/1099-176X(200006)3:2<61::AID-MHP74>3.0.CO;2-F","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72127423","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A programmatic approach to socially complex intervention development","authors":"Wayne S. Fenton","doi":"10.1002/1099-176X(200006)3:2<113::AID-MHP75>3.0.CO;2-H","DOIUrl":"https://doi.org/10.1002/1099-176X(200006)3:2<113::AID-MHP75>3.0.CO;2-H","url":null,"abstract":"<p>First used in psychiatry to study pharmacological treatments, the randomized controlled trial provides the most powerful test of the relative effectiveness of two or more interventions. Applying RCT methodology to socially complex service interventions, however, presents unique challenges that derive from difficulties in treatment standardization, attaining study sample equivalence and controlling for environmental variations. These challenges can be managed when intervention development proceeds along a programmatic trajectory that spans discovery, development, efficacy, effectiveness and practice research. Copyright © 2000 John Wiley &amp; Sons, Ltd.</p>","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"3 2","pages":"113-114"},"PeriodicalIF":1.6,"publicationDate":"2000-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/1099-176X(200006)3:2<113::AID-MHP75>3.0.CO;2-H","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72162499","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Organizing mental health services: an evidence-based approach","authors":"Howard H. Goldman,&nbsp;Sten Thelander,&nbsp;Claes-Goran Westrin","doi":"10.1002/1099-176X(200006)3:2<69::AID-MHP76>3.0.CO;2-1","DOIUrl":"https://doi.org/10.1002/1099-176X(200006)3:2<69::AID-MHP76>3.0.CO;2-1","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; &lt;b&gt;Background and Aims.&lt;/b&gt;&lt;/h3&gt;\u0000 \u0000 &lt;p&gt; Health policy makers and program developers seek evidence-based guidance on how to organize and finance mental health services. The Swedish Council on Technology Assessment in Health Care (SBU) commissioned a conceptual framework for thinking about health care services as a medical technology. The following framework was developed, citing empirical research from mental health services research as the case example.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; &lt;b&gt;Framework.&lt;/b&gt;&lt;/h3&gt;\u0000 \u0000 &lt;p&gt; Historically, mental health services have focused on the organization and locus of care. Health care settings have been conceptualized as medical technologies, treatments in themselves. For example, the field speaks of an era of ‘asylum treatment’ and ‘community care’. Hospitals and community mental health centers are viewed as treatments with indications and ‘dosages’, such as length of stay criteria. Assessment of mental health services often has focused on organizations and on administrative science.&lt;/p&gt;\u0000 \u0000 &lt;p&gt;There are two principal perspectives for assessing the contribution of the organization of services on health. One perspective is derived from clinical services research, in which the focus is on the impact of organized treatments (and their most common settings) on health status of individuals. The other perspective is based in service systems research, in which the focus is on the impact of organizational strategies on intermediate service patterns, such as continuity of care or integration, as well as health status.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; &lt;b&gt;Methods.&lt;/b&gt;&lt;/h3&gt;\u0000 \u0000 &lt;p&gt; Examples of empirical investigations from clinical services research and service systems research are presented to demonstrate potential sources of evidence to support specific decisions for organizing mental health services.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; &lt;b&gt;Results.&lt;/b&gt;&lt;/h3&gt;\u0000 \u0000 &lt;p&gt; Evidence on organizing mental health services may be found in both types of services research. In clinical services research studies, service settings are viewed as treatments (e.g. ‘partial hospitalization’), some treatments are always embedded in a service matrix (e.g. assertive community treatment), and, where some treatments are organizationally combined (e.g. ‘integrated treatment’ for co-occurring mental disorder and substance abuse), sometimes into a continuum of care. In service system research, integration of services and of the service system are the main focus of investigation. Studies focus on horizontal and vertical integration, primary care or specialty care and local mental health authorities—each of which ma","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"3 2","pages":"69-75"},"PeriodicalIF":1.6,"publicationDate":"2000-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/1099-176X(200006)3:2<69::AID-MHP76>3.0.CO;2-1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72162501","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using randomized controlled trials to evaluate socially complex services: problems, challenges and recommendations","authors":"Nancy Wolff","doi":"10.1002/1099-176X(200006)3:2<97::AID-MHP77>3.0.CO;2-S","DOIUrl":"https://doi.org/10.1002/1099-176X(200006)3:2<97::AID-MHP77>3.0.CO;2-S","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; &lt;b&gt;Background:&lt;/b&gt;&lt;/h3&gt;\u0000 \u0000 &lt;p&gt; Following the lead of evidence-based medicine, practice based on effectiveness research has become the new gold standard of contemporary public policy. Studies of this sort are increasingly demanded to evaluate services provided by mental health, social services and criminal justice systems.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; &lt;b&gt;Aims:&lt;/b&gt;&lt;/h3&gt;\u0000 \u0000 &lt;p&gt; The paper questions whether the simple randomized controlled trial (RCT) paradigm as applied in clinical trials can be used ‘off the rack’ to evaluate &lt;i&gt;socially complex service (SCS) interventions&lt;/i&gt;. These are services that are characterized by complex, diverse and non-standardized staffing arrangements; ambiguous protocols; hard-to-define study samples and unevenly motivated subjects and dependence on broader social environments. The difficulty of ensuring precise protocols, equivalent groups (tied to a meaningful target population) and neutral and equivalent trial environments under real world conditions are explored, as are the implications of not achieving standardization and equivalence.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; &lt;b&gt;Methods:&lt;/b&gt;&lt;/h3&gt;\u0000 \u0000 &lt;p&gt; Limitations of effectiveness research as a research tool and information source are examined by comparing the assumptions underpinning the simple RCT to the characteristics of SCS interventions, as illustrated by programs targeted to mentally disordered offenders in Britain.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; &lt;b&gt;Results:&lt;/b&gt;&lt;/h3&gt;\u0000 \u0000 &lt;p&gt; SCSs violate the assumptions underpinning the simple RCT model in ways that draw into sharp question the validity, reliability and generalizability of inferences of SCS trials.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; &lt;b&gt;Discussion:&lt;/b&gt;&lt;/h3&gt;\u0000 \u0000 &lt;p&gt; The RCT is not a panacea. Effectiveness research of SCS interventions that is based on the RCT model is unlikely to yield valid, reliable and generalizable inferences without becoming more complex in design and more sensitive to issues of selection bias, unmeasured variables and endogeneity. Ten recommendations are offered for stylizing the RCT design to the characteristics of socially complex services.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; &lt;b&gt;Implications:&lt;/b&gt;&lt;/h3&gt;\u0000 \u0000 &lt;p&gt; It remains an empirical issue whether RCT-based services effectiveness research can inform mental health policy. Without major design innovations, it is more likely that the information generated by this research will have limited practical use, especially if the RCT model is unable to control for the effect of socia","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"3 2","pages":"97-109"},"PeriodicalIF":1.6,"publicationDate":"2000-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/1099-176X(200006)3:2<97::AID-MHP77>3.0.CO;2-S","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72162503","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Abstracts translations","authors":"","doi":"10.1002/1099-176X(200006)3:2<115::AID-MHP84>3.0.CO;2-H","DOIUrl":"https://doi.org/10.1002/1099-176X(200006)3:2<115::AID-MHP84>3.0.CO;2-H","url":null,"abstract":"<p>To view the abstracts translations in Russian please go to the full text PDF file.</p>","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"3 2","pages":"115-117"},"PeriodicalIF":1.6,"publicationDate":"2000-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/1099-176X(200006)3:2<115::AID-MHP84>3.0.CO;2-H","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72162500","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Addiction:entries and exits. Edited by Jon Elster. New York: Sage, 1999","authors":"R. Pacula","doi":"10.1002/MHP.92","DOIUrl":"https://doi.org/10.1002/MHP.92","url":null,"abstract":"","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"21 1","pages":"165-166"},"PeriodicalIF":1.6,"publicationDate":"2000-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78740860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How can policy makers use available evidence on the cost benefits of drug treatement?","authors":"Christine Godfrey,&nbsp;Steve Parrott","doi":"10.1002/1099-176X(200003)3:1<55::AID-MHP70>3.0.CO;2-1","DOIUrl":"https://doi.org/10.1002/1099-176X(200003)3:1<55::AID-MHP70>3.0.CO;2-1","url":null,"abstract":"<p>All the studies on the cost benefits of drug treatment reviewed by Cartwright in this issue suggest benefits outweigh costs by some margin. What lessons does this review of mainly American data have for European policy makers? Drug treatments are associated with a wide range of consequences outside the health sector and there are considerable differences in treatment regimes across countries. This could well influence results. There are also considerable differences in methodologies used across available studies and many lack strong study designs. An interesting feature is the lack of valuation of individual drug users benefits, does this imply that policy makers in the US do not care about drug misusers. Would the situation be the same in Europe or other parts of the world? There is a lot of research to be done and perhaps specific guidelines are required to ensure economic evaluations in this area can be used to guide policy decisions with more confidence. Copyright ©2000 John Wiley &amp; Sons, Ltd.</p>","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"3 1","pages":"55"},"PeriodicalIF":1.6,"publicationDate":"2000-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/1099-176X(200003)3:1<55::AID-MHP70>3.0.CO;2-1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72157706","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost–benefit analysis of drug treatment services: review of the literature†","authors":"William S. Cartwright","doi":"10.1002/1099-176X(200003)3:1<11::AID-MHP66>3.0.CO;2-0","DOIUrl":"https://doi.org/10.1002/1099-176X(200003)3:1<11::AID-MHP66>3.0.CO;2-0","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Background:&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;How valuable is public investment in treatment for drug abuse and dependency in the real world of everyday practice? Does drug abuse treatment provide benefits and how are they valued? What are the costs of obtaining outcomes and benefits? Cost–benefit analysis attempts to answer these questions in a standard analytic framework.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Aims:&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;This paper reviews cost–benefit analyses with scientific merit so that analysts will have a current picture of the state of the research. It will also give public decision-makers information with regards to the available evidence for policy purposes.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Method:&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Bibliographic searches were performed. Studies were obtained through the assistance of the Parklawn Health Library system, a component of the US Public Health Service. Selected studies were from the scientific literature with the exception of eight studies published as governmental reports.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results:&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Cost–benefit studies have fallen into the following categories: (i) planning models for delivery systems in states and cities; (ii) short-term follow-up studies of individuals, (iii) single individual programs and (iv) state system's monitoring of outcomes. In 18 cost–benefit studies, a persistent finding is that benefits exceed costs, even when not all benefits are accounted for in the analysis. Much variation is found in the implementation of cost–benefit methods, and this is detailed across discussions of effectiveness, benefits and costs. Studies have emphasized the cost savings to society from the reduction in external costs created by the behavioral consequences of addiction and drug use.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Discussion:&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Economic analysis of drug treatment requires sophisticated conceptualization and measurement. Cost–benefit analysis of drug treatment has been a significant analytical exercise since the early 1970s when the public drug treatment system was founded in the United States.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusion:&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Drug abuse treatment services may be considered as contributing positive economic returns to society. However, considerable work needs to be done to standardize methods used in the studies. A striking area of omission is the absence of studies for adolescents and only one for women in treatment.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;","PeriodicalId":46381,"journal":{"name":"Journal of Mental Health Policy and Economics","volume":"3 1","pages":"11-26"},"PeriodicalIF":1.6,"publicationDate":"2000-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/1099-176X(200003)3:1<11::AID-MHP66>3.0.CO;2-0","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72157708","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}