メディケイド:施設の開設と閉鎖に関連した住宅治療におけるMOUDへの患者のアクセス増加, 2012-22
Tamara Beetham1, Helen Newton2, Chima D Ndumele3
1Tamara Beetham (tamara_beetham@brown.edu), Brown University, Providence, Rhode Island.
Health affairs (Project Hope)
|September 2, 2025
まとめ
メディケイドの免除により,オピオイド使用障害 (MOUD) の治療薬へのアクセスが拡大しました. 施設の入場と退出は,これらの改善を大きく推進し,政策の加速効果を強調しました.
科学分野:
- 医療サービス研究
- 公衆衛生政策
- 薬物使用障害の治療
背景:
- メディケイド第1115条の免除は2015年から 州が住宅中毒治療に 限られた資金を使うことを許可しました
- これらの免除は,これらの資金にアクセスするための新しい要件を導入し,治療の可用性に影響を与えました.
研究 の 目的:
- 住居中毒治療施設におけるオピオイド使用障害 (MOUD) の治療薬へのメディケイド患者のアクセスの変化を調査する.
- メディケイド第1115条の免除の実施後のMOUDアクセスに対する施設の売上高の影響を評価する.
主な方法:
- 施設レベルの調査データを活用した.
- 差異の差異の枠組みを準実験的に使った.
- 2012年から2022年のデータを分析し,介入状態と対照状態を比較した.
主要な成果:
- 免除措置の実施から4年後 介入州での施設では メディケイドを受け取り MOUD を提供する確率が26パーセント上昇しました
- 施設の入出は,この増加の89%を占め,新しい施設はMOUDを提供し,非MOUD施設は退出しました.
- 継続的に運営されている施設はメディケイドの参加が改善されたが,MOUDの利用は改善されなかった.
結論:
- 医療提供者の出入は 医療政策の変化の影響を加速させる上で 極めて重要です
- メディケイドの免除は 依存症治療の状況を変えて MOUDの利用可能性に影響を与えます
- ターゲットを絞った政策は 市場動態を活かして 根拠に基づいた治療へのアクセスを改善できます
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