Therapy costly for drugs, alcohol

Workers who require substance-abuse treatment are finding it increasingly difficult to pay for it, according to a new study published this week.

Using data from the Kaiser Family Foundation's Employer Health Benefits Survey researchers found that in 2006, employer-sponsored coverage for drug rehabilitation treatment is scant and does not provide the same protection given under medical and surgical benefits. In addition, annual limits and lifetime caps on the number of treatment visits and hospital stays also subvert substance-abuse coverage.

The declining coverage rates are a concern, as alcoholism and dependency on illegal drugs remain a serious problem. In 2005, approximately 22.2 million Americans age 12 or older were "dependent" or "abused" illicit drugs or alcohol. During the same year, three out of four persons with a drug or alcohol problem were employed either full or part time.

The decline in coverage is a new trend in employer-sponsored health insurance.

"In job-based insurance plans, substance-abuse treatment has been widely covered since 1989, when an estimated 88 percent of employees in midsize and large private firms had coverage, " the study said.

"Since that time, however, the rise of managed-care plans and their associated benefit design [utilization controls and cost-sharing] may be a major factor in the relative decline of spending by private plans."

Last year, cost sharing was higher for substance-abuse services than for other medical procedures, such as routine physicals. For example, workers paid on average a $443 deductible for substance-abuse services and $300 for medical services.

A growing concern is new limits employers set on the amount of substance-abuse coverage. In 2006, only 19 percent of U.S. workers enrolled in a health plan without limits on the number of doctor visits or hospitals stays when dealing with a drug or alcohol problem.

"Such limitations are virtually unknown in general medical care, where nearly all covered workers had unlimited medical and surgical hospital days and office visits, "said Jon Gabel, a senior fellow at the National Opinion Research Center in Washington in a study published yesterday in Health Affairs.

Caps on substance-abuse treatment options were more prevalent last year than in 1989, when nearly 50 percent of workers received the same coverage for substance problems as for medical and surgical services.

Since the early 1990s, Medicare and Medicaid have taken on an increasing amount of spending for substance-abuse problems, while the private payers' share has declined. Over the past 10 years, private insurance spending for substance-abuse services declined from 22 percent of all medical services in 1991 to 10 percent in 2003.

At the same time, costs for the coverage are escalating. Last year, workers with substance-abuse benefits paid deductibles that were, on average, 46 percent higher than medical and surgical deductibles. And, overall spending on substance abuse is also significant. In 2003, medical spending for substance-abuse treatment constituted an estimate $20.7 billion, or one third of all health care spending.

"People who try to get care for substance abuse but aren't successful most often say that cost is the reason," said Dr. Gabel. "The economic costs of not treating substance abuse can be many times the costs of treatment. Yet the higher cost sharing for substance-abuse problems that many workers face can discourage them from seeking treatment."

c Health Care runs Fridays. Contact Gregory Lopes at 202/636-4892 or glopes@washingtontimes.com.