Today, more than 80 percent of American workers are in some form of managed care health plan, compared to about 29 percent in 1988. While managed care has put some much-needed controls on the delivery of services, experts say that it has also forced many substance abuse treatment centers to close or cut back on services. A 1996 story in the VILLAGE VOICE reported that in the past decade, over half of the country's private treatment centers have closed.
Also, ten years ago, insured people who received inpatient treatment could often get 28 days of care, which costs about $14,000. Today the average covered length of stay is closer to 7.7 days. "Inpatient care for addiction treatment has been virtually eliminated," says Mark Covall, executive director of the National Association of Psychiatric Health Systems. "What you see today is very much an outpatient-oriented program with very short stays in the hospital, primarily for detoxification."
As a result, says experts, patients who are sick enough to be in a residential setting are now having to seek care in outpatient and evening treatment programs, which may not provide enough support for lasting results. Jack Gronewald, COO of the Ridgeview Institute, a treatment facility, says, "For some patients, [the shorter stays] have led to almost a revolving door." He adding that rates of relapse have been greater since the advent of managed care. Providers are having to cram a lot more information into shortened courses of treatment, they say, and patients are having to absorb much more, at a time when they are likely to be shaky, confused, and still craving their drug of choice.
Thomas McLellan, Ph.D., a professor at the Center for Studies of Addiction at the University of Pennsylvania School of Medicine, agrees. In studies in Philadelphia, he says, managed care has reduced the quality of services, compared to those available under traditional insurance coverage. "[With more extensive treatment,] we saw significant changes in employment, family function, and psychiatric status; and they were quite related to the provision of services for those problems. When those services were cut, you saw increases in alcohol and drug use," he says.