Improving the Quality of Addiction Treatment

To bring market forces to bear on health care improvement, one needs service consumers who (a) Can detect quality (b) Are aware of what they are paying and (c) Have choices between providers. These three things are rarely true of the people who receive services from public sector addiction treatment programmes.

One way to handle this problem is to create an artificial market within a public health care system, i.e., have experts measure quality of care and then pay a bonus to treatment providers who offer the highest quality services. The Veterans Health Administration has done this for years, with impressive effects. But, in a paper kindly flagged by Austin Frakt today, my colleagues and I found that this approach has been less successful at improving the outcomes of addiction treatment.

Author: Keith Humphreys

Keith Humphreys is the Esther Ting Memorial Professor of Psychiatry at Stanford University and an Honorary Professor of Psychiatry at Kings College London. His research, teaching and writing have focused on addictive disorders, self-help organizations (e.g., breast cancer support groups, Alcoholics Anonymous), evaluation research methods, and public policy related to health care, mental illness, veterans, drugs, crime and correctional systems. Professor Humphreys' over 300 scholarly articles, monographs and books have been cited over thirteen thousand times by scientific colleagues. He is a regular contributor to Washington Post and has also written for the New York Times, Wall Street Journal, Washington Monthly, San Francisco Chronicle, The Guardian (UK), The Telegraph (UK), Times Higher Education (UK), Crossbow (UK) and other media outlets.

5 thoughts on “Improving the Quality of Addiction Treatment”

  1. Keith, aren’t you supposed to be on vacation? Vacate! You need a nice rest.

    1. David Mamet says that when he has no good ideas for plays, he write film scripts. When I am not doing any real work, I blog!

      But I appreciate the thought Lowry.


  2. To the extent I understood the paper: why are there plenty of people and money around to supervise parolees and probationers, but not enough resources when it comes to following up on veterans’ health care? Also, why not ask the veterans who’ve sobered up how they did it?

    1. NCG: Actually, people on probation and parole are often poorly supervised, caseloads are huge and monitoring is minimal. As the article mentions, the VA does have a system that follows-up on outcomes after treatment, that’s how we know that, unfortunately, some of performance measures incentivized during treatment didn’t translate into better long-term outcomes

      1. Okay, I misunderstood then, because it seemed as if the paper said that certain kinds of follow-up, which might be helpful to you, were too expensive to get regularly. And that seemed wrong to me, since I don’t see anything better that we should spend our money on.

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