At the Intersection of Health, Health Care and Policy Cite this article as: Marcus A. Bachhuber and Chinazo O. Cunningham For-Profit Treatment Of Opioid Addiction Health Affairs, 32, no.11 (2013):2060 doi: 10.1377/hlthaff.2013.1100
The online version of this article, along with updated information and services, is available at: http://content.healthaffairs.org/content/32/11/2060.1.full.html
For Reprints, Links & Permissions: http://healthaffairs.org/1340_reprints.php E-mail Alerts : http://content.healthaffairs.org/subscriptions/etoc.dtl To Subscribe: http://content.healthaffairs.org/subscriptions/online.shtml
Health Affairs is published monthly by Project HOPE at 7500 Old Georgetown Road, Suite 600, Bethesda, MD 20814-6133. Copyright © 2013 by Project HOPE - The People-to-People Health Foundation. As provided by United States copyright law (Title 17, U.S. Code), no part of Health Affairs may be reproduced, displayed, or transmitted in any form or by any means, electronic or mechanical, including photocopying or by information storage or retrieval systems, without prior written permission from the Publisher. All rights reserved.
Not for commercial use or unauthorized distribution Downloaded from content.healthaffairs.org by Health Affairs on May 22, 2015 at UNIVERSITY OF MANCHESTER
Letters There is a limit of 300 words for letters to the editor. Health Affairs reserves the right to edit all letters for clarity, length, and tone. Letters can be submitted by e-mail, [email protected], or the Health Affairs website, http:// www.healthaffairs.org.
doi:
10.1377/hlthaff.2013.1100
For-Profit Treatment Of Opioid Addiction We agree with Bohdan Nosyk and colleagues (Aug 2013) that office-based treatment with methadone for opioid dependence should be available. Methadone clinics (and, more generally, opioid treatment programs) in the United States are undergoing a transformation in ownership. In 2000, 43 percent of programs were for profit, but in 2011, 54 percent were. Nonprofit and public programs decreased from 43 percent to 36 percent and from 14 percent to 10 percent, respectively. 1,2 Beyond opioid agonist treatment, many programs offer patients important medical and psychiatric services, such as screening for HIV. However, these services are not mandated by government regulations, and programs might not be reimbursed for providing them if, for example, patients are uninsured or have limited coverage. To decrease costs and increase profits, for-profit programs might not offer these services, putting patients at risk for poor health outcomes. When for-profit programs cut costs, patients do not save. In a national study of methadone programs,3 forprofit programs spent less on clinical
2060
Health Affai rs
care on average per patient, per year, than nonprofit and public programs did. However, for-profit programs also collected higher out-of-pocket fees, on average, per patient per year ($2,237 in 2000 dollars) than nonprofit and public programs did ($493). Patients in for-profit programs receive less care than their counterparts in nonprofit and public programs, but they pay substantially more for it. Although for-profit programs probably do provide benefits, their role in delivering treatment services deserves scrutiny. Marcus A. Bachhuber Philadelphia Veterans Affairs Medical Center PHILADELPHIA , PENNSYLVANIA Chinazo O. Cunningham Albert Einstein College of Medicine BRONX , NEW YORK NOTES 1 Substance Abuse and Mental Health Services Administration. National Survey of Substance Abuse Treatment Services: 2000. Rockville (MD): SAMHSA; 2002. 2 Substance Abuse and Mental Health Services Administration. National Survey of Substance Abuse Treatment Services: 2011. Rockville (MD): SAMHSA; 2012. 3 Wechsberg WM, Kasten JJ, Berkman ND, Roussel AE. Methadone maintenance treatment in the U.S.: a practical question and answer guide. New York (NY): Springer; 2007.
N OV EM B E R 2 0 1 3
32:11
Downloaded from content.healthaffairs.org by Health Affairs on May 22, 2015 at UNIVERSITY OF MANCHESTER
The online version of this article, along with updated information and services, is available at: http://content.healthaffairs.org/content/32/11/2060.1.full.html
For Reprints, Links & Permissions: http://healthaffairs.org/1340_reprints.php E-mail Alerts : http://content.healthaffairs.org/subscriptions/etoc.dtl To Subscribe: http://content.healthaffairs.org/subscriptions/online.shtml
Health Affairs is published monthly by Project HOPE at 7500 Old Georgetown Road, Suite 600, Bethesda, MD 20814-6133. Copyright © 2013 by Project HOPE - The People-to-People Health Foundation. As provided by United States copyright law (Title 17, U.S. Code), no part of Health Affairs may be reproduced, displayed, or transmitted in any form or by any means, electronic or mechanical, including photocopying or by information storage or retrieval systems, without prior written permission from the Publisher. All rights reserved.
Not for commercial use or unauthorized distribution Downloaded from content.healthaffairs.org by Health Affairs on May 22, 2015 at UNIVERSITY OF MANCHESTER
Letters There is a limit of 300 words for letters to the editor. Health Affairs reserves the right to edit all letters for clarity, length, and tone. Letters can be submitted by e-mail, [email protected], or the Health Affairs website, http:// www.healthaffairs.org.
doi:
10.1377/hlthaff.2013.1100
For-Profit Treatment Of Opioid Addiction We agree with Bohdan Nosyk and colleagues (Aug 2013) that office-based treatment with methadone for opioid dependence should be available. Methadone clinics (and, more generally, opioid treatment programs) in the United States are undergoing a transformation in ownership. In 2000, 43 percent of programs were for profit, but in 2011, 54 percent were. Nonprofit and public programs decreased from 43 percent to 36 percent and from 14 percent to 10 percent, respectively. 1,2 Beyond opioid agonist treatment, many programs offer patients important medical and psychiatric services, such as screening for HIV. However, these services are not mandated by government regulations, and programs might not be reimbursed for providing them if, for example, patients are uninsured or have limited coverage. To decrease costs and increase profits, for-profit programs might not offer these services, putting patients at risk for poor health outcomes. When for-profit programs cut costs, patients do not save. In a national study of methadone programs,3 forprofit programs spent less on clinical
2060
Health Affai rs
care on average per patient, per year, than nonprofit and public programs did. However, for-profit programs also collected higher out-of-pocket fees, on average, per patient per year ($2,237 in 2000 dollars) than nonprofit and public programs did ($493). Patients in for-profit programs receive less care than their counterparts in nonprofit and public programs, but they pay substantially more for it. Although for-profit programs probably do provide benefits, their role in delivering treatment services deserves scrutiny. Marcus A. Bachhuber Philadelphia Veterans Affairs Medical Center PHILADELPHIA , PENNSYLVANIA Chinazo O. Cunningham Albert Einstein College of Medicine BRONX , NEW YORK NOTES 1 Substance Abuse and Mental Health Services Administration. National Survey of Substance Abuse Treatment Services: 2000. Rockville (MD): SAMHSA; 2002. 2 Substance Abuse and Mental Health Services Administration. National Survey of Substance Abuse Treatment Services: 2011. Rockville (MD): SAMHSA; 2012. 3 Wechsberg WM, Kasten JJ, Berkman ND, Roussel AE. Methadone maintenance treatment in the U.S.: a practical question and answer guide. New York (NY): Springer; 2007.
N OV EM B E R 2 0 1 3
32:11
Downloaded from content.healthaffairs.org by Health Affairs on May 22, 2015 at UNIVERSITY OF MANCHESTER
