A Rutgers analysis of medical records reveals sharp disparities in use of drug addiction services based on insurance type
As public health insurance in the United States faces potential cuts, a Rutgers University review of medical records finds that Medicaid and Medicare patients with opioid addiction tend to receive behavioral health care services less often than those with other types of funding.
"What's most striking is how insurance type fundamentally shapes patient treatment," said Jamey Lister, an associate professor at the Rutgers School of Social Work and principal investigator of the study published in the journal Addiction Science & Clinical Practice. "We discovered that patients with public insurance alone were less likely to utilize treatment services compared to those with multiple funding sources."
We should aspire to provide health care services that are driven by patient need, not by financing. But as we found, if you're only using public insurance, you're likely falling through the cracks.
Jamey Lister
Associate Professor, Rutgers School of Social Work
About 10% of American adults have co-occurring substance use and mental health disorders, highlighting the need for integrated treatment planning. To determine what motivates - or prevents - them from seeking care, Lister and colleagues analyzed records from patients registered at a community health center in New Jersey between 2015 and 2021, a period that coincided with the state's Medicaid expansion under the Affordable Care Act.
In collaboration with the Rutgers Health Center for Integrated Care and Trinitas Regional Medical Center, an RWJBarnabas Health clinic in Elizabeth, N.J., the researchers reviewed electronic medical records of 705 patients diagnosed with opioid use disorder.
Roughly 72% of the study sample had both opioid use and another substance use disorder - such as cannabis, cocaine or alcohol. Nearly 40% had a co-occurring mental health disorder. Forty percent were Black or African American and 70.6% were male.
The researchers analyzed these results for service utilization, including metrics such as the average number of psychotherapy and group therapy sessions attended. Patients were then grouped by insurance type (Medicaid or Medicare, charity, other public or private) and condition.
They found that patients with Medicaid or Medicare in combination with other forms of public health insurance - such as court- or probation-mandated treatment - received more than twice as many sessions than those with only Medicaid or Medicare, despite having similar health care needs.
Lister said the findings carry significant implications for ongoing healthcare policy discussions. Changes to public health insurance programs could dramatically affect treatment access and uptake, especially for the most vulnerable, said researchers involved in the study.
"It's the exact opposite of how we should be helping people," said Lister. "We should aspire to provide health care services that are driven by patient need, not by financing. But as we found, if you're only using public insurance, you're likely falling through the cracks."
Reducing public health insurance, as proposed by some lawmakers, would exacerbate these trends - especially given the gaps in coverage that persisted after Medicaid was expanded in New Jersey a decade ago, Lister said.
It would also be costly. A 2021 study published by the American Medical Association found that improving access to opioid use disorder treatments can save between $25,000 to $105,000 in lifetime costs per person, while overdoses and deaths account for billions in healthcare and criminal justice system costs each year.
One bright spot in the research was the methodology. By using a "team science" approach -bringing together social work faculty, psychologists, clinical directors, data analysts and doctoral students - the researchers created a unique patient population snapshot that large state or federal datasets typically cannot replicate.
"Clinics will always collect patient data for insurance purposes, reimbursements and quality improvement or assurance," Lister said. "Through partnerships and team science approaches, we can use big data to help identify needs within a specific patient subset that can inform treatment planning for health centers across the country."
The work was supported by the Health Resources and Services Administration of the U.S. Department of Health and Human Services.
