Sunday Azagba1, Lingpeng Shan2, Mark Hall3, Mark Wolfson4, Frank Chaloupka5. 1. Penn State College of Nursing, University Park, PA 16802, USA. Electronic address: spa5695@psu.edu. 2. Division of Biostatistics, College of Public Health, The Ohio State University, USA. 3. Department of Social Sciences and Health Policy, Wake Forest School of Medicine, USA. 4. Department of Social Medicine, Population, and Public Health, University of California Riverside School of Medicine, Riverside, CA 92501, USA. 5. School of Public Health, the University of Illinois at Chicago, USA.
Abstract
BACKGROUND: Many states in the U.S. still have Alcohol Exclusion Laws (AELs), which allow insurance companies to deny health claims resulting from alcohol impairment. There are concerns that this form of structural stigmatization affects alcohol treatment-seeking behaviors. We examined the effects of AEL repeal on treatment admissions for alcohol use disorder (AUD). METHODS: Data on alcohol treatment admissions from 1992 to 2017 were obtained from the Treatment Episode Data Set. The state-level aggregate number of treatment admissions was derived, including healthcare professional referrals only, self-referrals only, and both self-referral and healthcare professional referrals. The number of treatment admissions by health insurance status (private, public, and uninsured) was also calculated. The study used a difference-in-differences (DID) quasi-experimental design. RESULTS: The DID analysis showed that the number of admissions for alcohol treatment from healthcare professional referrals increased 16% in the AEL repeal states compared to states with AELs or that never had AELs (IRR=1.16, 95% CI=1.07, 1.25). These results were consistent for analysis by payment sources. In particular, treatment admissions from healthcare professional referrals for patients covered by private insurance increased about 38% in states with AEL repeal (IRR=1.38, 95% CI=1.17, 1.64) compared to states without AEL repeal. However, the findings were no longer significant when the state-specific time trends were taken into account. CONCLUSIONS: This study documented that AEL repeal may have had a significant impact on the number of treatment admissions for AUD. These findings suggest that AELs function as a barrier to treatment-seeking behavior.
BACKGROUND: Many states in the U.S. still have Alcohol Exclusion Laws (AELs), which allow insurance companies to deny health claims resulting from alcohol impairment. There are concerns that this form of structural stigmatization affects alcohol treatment-seeking behaviors. We examined the effects of AEL repeal on treatment admissions for alcohol use disorder (AUD). METHODS: Data on alcohol treatment admissions from 1992 to 2017 were obtained from the Treatment Episode Data Set. The state-level aggregate number of treatment admissions was derived, including healthcare professional referrals only, self-referrals only, and both self-referral and healthcare professional referrals. The number of treatment admissions by health insurance status (private, public, and uninsured) was also calculated. The study used a difference-in-differences (DID) quasi-experimental design. RESULTS: The DID analysis showed that the number of admissions for alcohol treatment from healthcare professional referrals increased 16% in the AEL repeal states compared to states with AELs or that never had AELs (IRR=1.16, 95% CI=1.07, 1.25). These results were consistent for analysis by payment sources. In particular, treatment admissions from healthcare professional referrals for patients covered by private insurance increased about 38% in states with AEL repeal (IRR=1.38, 95% CI=1.17, 1.64) compared to states without AEL repeal. However, the findings were no longer significant when the state-specific time trends were taken into account. CONCLUSIONS: This study documented that AEL repeal may have had a significant impact on the number of treatment admissions for AUD. These findings suggest that AELs function as a barrier to treatment-seeking behavior.
Authors: Wendy R Greene; Tolulope A Oyetunji; Umar Bowers; Adil H Haider; Thomas A Mellman; Edward E Cornwell; Suryanarayana M Siram; David C Chang Journal: Am J Surg Date: 2010-04 Impact factor: 2.565
Authors: Larry M Gentilello; Anthony Donato; Susan Nolan; Robert E Mackin; Franesa Liebich; David B Hoyt; Richard A LaBrie Journal: J Trauma Date: 2005-09
Authors: Mark A Ilgen; Amanda M Price; Inger Burnett-Zeigler; Brian Perron; Khairul Islam; Amy S B Bohnert; Kara Zivin Journal: Drug Alcohol Depend Date: 2010-09-15 Impact factor: 4.492