Cost of Substance Abuse to Healthcare System - Medicaid | CASAColumbia

The Cost of Substance Abuse to America's Health Care System, Report 1: Medicaid Hospital Costs

The Cost of Substance Abuse to America's Health Care System, Report 1: Medicaid Hospital Costs

Published: July 1993

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Background

This report is one in a series of reports evaluating the cost of addiction to America’s health care system. It focuses on costs of substance abuse to Medicaid funded hospital care.

Methods

This analysis involved a review of research studies, all meeting predetermined inclusion criteria, that identified substance abuse (tobacco, alcohol or drugs) as a major risk factor for acquiring a given disease/condition. Based on this research, statistical analyses were conducted to evaluate the risk of a particular health condition that can be attributed to substance abuse or addiction, in whole or in part, and the cost of these conditions to Medicaid programs.
Results

The report found that at least 1 of every 5 Medicaid dollars spent on hospital care and 1 in every 5 Medicaid covered hospital days were attributable to substance abuse. In 1991, the latest year for which detailed information was available and the year on which this study is based, Medicaid spent $4.2 billion of its $21.6 billion in inpatient hospital expenditures on substance-abuse-related care. Based on these results, it was estimated that for fiscal year 1994, substance-abuse-related costs would rise to $7.4 billion.

Results

This report also found several factors that contributed to the cost of substance use and addiction:

  • More than 70 conditions requiring hospitalization were attributable in whole or in part to substance abuse
  • On average, Medicaid patients with substance abuse as a secondary diagnosis were hospitalized twice as long as patients with the same primary diagnosis and no substance abuse
  • Men under 15 years of age with substance abuse as a primary or secondary diagnosis stayed in the hospital 4 times longer than those with no such diagnoses (16.4 days vs 3.9 days); women in the same age group with substance abuse as a primary or secondary diagnosis stayed almost 3 times longer than those with no such diagnoses (9.8 days vs 3.6 days)
  • Substance abuse complicated treatment for specific illnesses; patients treated for burns, pneumonia, and septicemia who had a secondary diagnosis of substance abuse stayed more than twice as long as those without such a diagnosis
  • Substance abuse has a significant impact not only on pregnancy and birth outcomes, but also on lifelong health care costs for infants born to substance-abusing mothers.

Recommendations

The report found that any health reform that hopes to offer care to all Americans at a reasonable cost must mount an all-fronts attack on all substance abuse—involving both legal and illegal drugs.  Specific recommendations include a call for Medicaid benefits to explicitly cover prevention and treatment of substance abuse and requirements for states to offer such benefits.

A Note on the Language
In 2012, CASAColumbia stopped using words like “drug abuse”/“drug abuser” because the terms have negative connotations. Instead, we now distinguish between “addiction” (clinical criteria for the disease) and “risky use” (use of addictive substances in ways that increase the risk of harm but do not meet criteria for addiction). Some reports and other publications published prior to 2012 still contain this outdated language.

 

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