The number of people who received inpatient treatment for drug and alcohol abuse at state-contracted facilities in Massachusetts has remained nearly unchanged since 2006, despite the expansion of insurance coverage under the state law passed that year.
Authors of a study published Monday in the journal Health Affairs said their results show that increasing coverage, while helpful, is not enough to get people with addictions the care they need. Changing how care is paid for and increasing capacity for treating people with addictions is necessary, too, they said.
Between 2006 and 2010, the number of addiction admissions at the treatment centers in Massachusetts held about steady at slightly more than 100,000 per year.
“If you build a system to serve 100,000 people and you don’t do too much to change it, it’s going to continue to do that,” said lead author Victor Capoccia, a senior scientist at the Center for Health Enhancement System Studies at the University of Wisconsin-Madison, who has held various roles in addiction services in Massachusetts.
Capoccia said that the state has a better system of care than many states, with more generous Medicaid benefits for addiction services and a greater investment from the state. The results here could serve as a warning to other states that expansion of insurance under the federal law that requires most Americans to have coverage starting in 2014, will not be enough to provide people with the care they need.
The study authors looked at statewide data and conducted interviews with leaders of community-based treatment organizations serving urban and suburban areas that accounted for about 30 percent of addiction admissions reported to the state between 2006 and 2009.
While about 98 percent of adults in Massachusetts now have health insurance, those interviewed estimated that between 23 percent and 30 percent of people they served were uninsured. Capoccia attributed that to high rates of “churn,” when people move in and out of coverage because they lose a job, are knocked off a subsidized plan when their income increases, or move and stop receiving renewal notices.
Michael Botticelli, director of the state Bureau of Substance Abuse Services, said the percentage of people with addictions who are uninsured has fallen -- he estimated a drop to 25 percent from 35 percent before the 2006 law -- but not as much as expected. Getting people with addictions, and those ages 18 to 25 in particular, to enroll in health insurance even when they qualify for assistance is a challenge, he said.
“Self-care behavior is not the hallmark of people with addictive disorders,” he said.
Better outreach is needed, he said. The state has focused much of its efforts on getting more addiction services into primary care settings, including working with Boston Medical Center to train community health centers throughout the state to provide such care, a program that has been particularly effective for treating young adults, he said. Those services include use of relatively new medications to control cravings, including buprenorphine.
The authors of the study acknowledged that they had gaps in their data. The study does not account for the possibility that more people are getting help in the outpatient setting and from providers that don’t report data to the state. Capoccia said he hopes that is what’s happening, though outpatient services are still quite limited.