Key Takeaways

From the Authors As published in the article
  1. Variations in health service utilization for substance use disorders (SUDs) across US counties—by insurance payers and self-pay—remain largely unexplored.
  2. Medicaid played a disproportionately large role in funding over half of the examined SUD service expenditures.
  3. Although health insurance alone cannot guarantee access to SUD services, our findings quantify its critical role in supporting access to and utilization of SUD services.
Extended Takeaways
  1. Self-pay represented 43.0% of SUD service utilizations but only 5.1% of SUD service expenditures, indicating that a large share of SUD care is occurring through lower-cost ambulatory care and prescriptions rather than more intensive covered services.
  2. County-level SUD utilization varied markedly, with 23.3% of counties below 3.0 per 1,000 residents and 9.3% at ≥10.0 per 1,000 residents, suggesting that local treatment access and financing conditions differ enough to warrant county-targeted planning rather than state-level assumptions alone.
  3. The uninsured rate was the strongest county-level correlate of lower SUD service use across overall utilization, self-pay, and Medicaid models, with Model 4 β values of −.45, −.40, and −.46, respectively; counties with high uninsured rates may therefore be especially important targets for insurance enrollment and coverage stabilization efforts.
  4. Unemployment showed payer-specific associations: it was positively associated with SUD utilization overall, for self-pay, and for Medicaid, but negatively associated with private insurance utilization (Model 4: β = −.12, P < .0001), which is clinically relevant in areas where employer-sponsored coverage may be more vulnerable during economic downturns.
  5. Compared with overall health care utilization, county characteristics explained much more of the variation in SUD service use than general medical use, with Model 4 accounting for 57.5% of SUD variance versus 20.2% for overall health conditions, supporting the need to assess SUD service infrastructure and financing separately from general health care capacity.
  6. Differences between high- and low-use counties were especially large for Medicaid, where top- versus bottom-quintile counties differed 10.4-fold (16.6 vs 1.6 per 1,000 county Medicaid enrollees), larger than the corresponding gaps for self-pay and private insurance, highlighting Medicaid’s central role in counties with the greatest SUD treatment intensity.
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Physicians Postgraduate Press, Inc. (PPP) makes no warranties about the accuracy or completeness of any information published in The Journal of Clinical Psychiatry or other PPP materials, and disclaims liability for any use or non-use of that information. Clinicians should not rely solely on these materials and should exercise their own professional judgment when making patient care decisions on an individualized basis.

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