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Alcohol, Drug Abuse, and Mental Health Care for Uninsured and Insured Adults


  • Kenneth B. Wells,

  • Cathy Donald Sherbourne,

  • Roland Sturm,

  • Alexander S. Young,

  • M. Audrey Burnam

Funded by The Robert Wood Johnson Foundation, Healthcare for Communities Grant No. 031280, and The National Institute of Mental Health (NIMH), Research Center on Managed Care for Psychiatric Disorders Grant No. MHO 1170-04.

Kenneth B. Wells, M.D., M.P.H., RAND, 1700 Main Street, Santa Monica, CA 90407-2138. Dr. Wells is also with the UCLA Neuropsychiatric Institute and Hospital, University of California, Los Angeles. Cathy Donald Sherbourne, Ph.D., Roland Sturm, Ph.D., and M. Audrey Burnam, Ph.D., are with RAND. Alexander S. Young, M.D., M.S.H.S., is with the UCLA Neuropsychiatric Institute and Hospital, University of California, Los Angeles, and the Department of Veterans Affairs, VISN 22, Mental Illness Research, Education and Clinical Center (MIRECC), West Los Angeles Veterans Healthcare Center, Los Angeles.


Objective To compare adults with different insurance coverage in care for alcohol, drug abuse, and mental health (ADM) problems.

Data Sources/Study Setting. From a national telephone survey of 9,585 respondents.

Design. Follow-up of adult participants in the Community Tracking Study.

Data Collection. Self-report survey of insurance plan (Medicare, Medicaid, unmanaged, fully, or partially managed private, or uninsured), ADM need, use of ADM services and treatments, and satisfaction with care in the last 12 months.

Principal Methods. Logistic and linear regressions were used to compare persons by insurance type in ADM use.

Principal Findings The likelihood of ADM care was highest under Medicaid and lowest for the uninsured and those under Medicare. Perceived unmet need was highest for the uninsured and lowest under Medicare. Persons in fully rather than partially managed private plans tend to be more likely to have ADM care and ADM treatments given need. Satisfaction with care was high in public plans and low for the uninsured.

Conclusions. The uninsured have the most problems with access to and quality of ADM care, relative to the somewhat comparable Medicaid population. Persons in fully managed plans had better rather than worse access and quality compared to partially managed plans, but findings are exploratory. Despite low ADM use, those with Medicare tend to be satisfied. Across plans, unmet need for ADM care was high, suggesting changes are needed in policy and practice.

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