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The decision to expand substance abuse treatment services: Assessing impact from the policymaker's perspective

Humphreys K, Wagner TH, Schaefer J, Gage M. The decision to expand substance abuse treatment services: Assessing impact from the policymaker's perspective. Presented at: International Society for the Study of Drug Policy Annual Conference; 2007 Mar 22; Oslo, Norway.


Substance abuse treatment advocates are often surprised when health care decision makers (e.g., hospital directors) are unmoved by evidence that treatment benefits drug users and lowers crime. The failure of health care decision makers to expand treatment on the basis of such evidence is often attributed to stigma, callousness or lack of managerial judgment. This paper argues that these interpretations are usually wrong, and that it is perfectly rational for health care decision makers not to change policy on the basis of data that addresses only one part of a population for which the decision maker is responsible (e.g., drug users), or touts economic benefits that will not appear on a health agency’s balance sheet (e.g., reduced costs to courts and jails). The present project is an effort to address empirically how expanding or reducing treatment services affects outcomes that health care decision makers care about. Specifically, using historical data from 1998-2004 from the Department of Veterans Affairs, we examine how hospitals’ decision to expand or reduce substance abuse treatment affected the hospital itself. Outcomes include whether substance abuse treatment pulls drug users out of more expensive units of the hospital (e.g., hepatology, psychiatry), thereby saving the hospital money, or, alternatively, whether it attracts sicker patients to all parts of the hospital, thereby raising costs. We will present a case study that illustrates our method and shows the potentially counter-intuitive effects of substance abuse treatment policy decisions by hospitals. We will also present pilot results of our larger analysis of the VA system nationwide.

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