Directed funding to address under-provision of treatment for substance use disorders: a quantitative study

Implementation Science

Steven Pizer²  Matthew Neuman³  Amy Wallace¹  Jodie Trafton³  Austin B Frakt² 

[1] Department of Psychiatry, Veterans Administration North Texas Health Care System, Bonham, TX, USA;Healthcare Financing & Economics, VA Boston Healthcare System and School of Medicine, Boston University, Boston, MA, USA;Program Evaluation and Resource Center, VA Palo Alto Healthcare System, Menlo Park CA, USA

关键词: Funding;    Veterans Health Administration;    Veterans;    Substance use disorder;   

Others  :  813496
DOI  :  10.1186/1748-5908-8-79

 received in 2012-10-05, accepted in 2013-04-30,  发布年份 2013

【 摘 要 】

Background

Substance use disorders (SUDs) are a substantial problem in the United States (U.S.), affecting far more people than receive treatment. This is true broadly and within the U.S. military veteran population, which is our focus. To increase funding for treatment, the Veterans Health Administration (VA) has implemented several initiatives over the past decade to direct funds toward SUD treatment, supplementing the unrestricted funds VA medical centers receive. We study the ‘flypaper effect’ or the extent to which these directed funds have actually increased SUD treatment spending.

Methods

The study sample included all VA facilities and used observational data spanning years 2002 to 2010. Data were analyzed with a fixed effects, ordinary least squares specification with monetized workload as the dependent variable and funding dedicated to SUD specialty clinics the key dependent variable, controlling for unrestricted funding.

Results

We observed different effects of dedicated SUD specialty clinic funding over the period 2002 to 2008 versus 2009 to 2010. In the earlier period, there is no evidence of a significant portion of the dedicated funding sticking to its target. In the later period, a substantial proportion—38% in 2009 and 61% in 2010—of funding dedicated to SUD specialty clinics did translate into increased medical center spending for SUD treatment. In comparison, only five cents of every dollar of unrestricted funding is spent on SUD treatment.

Conclusions

Relative to unrestricted funding, dedicated funding for SUD treatment was much more effective in increasing workload, but only in years 2009 and 2010. The differences in those years relative to prior ones may be due to the observed management focus on SUD and SUD-related treatment in the later years. If true, this suggests that in a centrally directed healthcare organization such as the VA, funding dedicated to a service is a necessary, but not sufficient condition for increasing resources expended for that service.

【 授权许可】

   
2013 Frakt et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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