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

机译：指导资金以解决药物滥用疾病的治疗不足：一项定量研究

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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.
机译：背景技术物质使用障碍（SUD）在美国（美国）是一个重大问题，影响的人数远远超过接受治疗的人数。这在美国退伍军人中广泛存在，这是我们关注的重点。为了增加治疗资金，退伍军人卫生管理局（VA）在过去十年中实施了多项举措，将资金用于SUD治疗，以补充VA医疗中心获得的无限制资金。我们研究了“蝇纸效应”或这些定向基金实际上在多大程度上增加了SUD治疗支出。方法研究样本包括2002年至2010年的所有VA设施和使用的观测数据。以固定效应，以货币化工作量为因变量的普通最小二乘规范以及以SUD专科门诊为主要因变量的资金进行分析，对数据进行分析。不受限制的资金。结果我们观察到2002年至2008年与2009年至2010年期间，SUD专科诊所专项资金的效果不同。在较早的时期，没有证据表明专项资金有很大一部分坚持其目标。在后期，用于SUD专科诊所的大量资金（2009年为38％，2010年为61％）确实转化为医疗中心用于SUD治疗的支出增加了。相比之下，无限制使用的每一美元资金中只有5美分用于SUD治疗。结论相对于无限制的资金投入，用于SUD治疗的专项资金在增加工作量方面更为有效，但仅在2009年和2010年。与前些年相比，这些年份的差异可能是由于观察到的管理层对SUD和SUD相关的关注在以后的治疗中。如果为真，则表明在诸如VA之类的集中医疗机构中，专门用于服务的资金是增加该服务所花费资源的必要条件，但不是充分条件。

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