PDF(Pubmed)
Abstract：
Expanding Medicaid plays a large role in ensuring that people across the United States have access to health care services. Although North Carolina recently moved toward Medicaid expansion, the impact of expansion on overdoses and overdose mortality may vary based on the type of treatment (offering medications for opioid use disorder [MOUD] vs. offering inpatient medically managed withdrawal without linkage to further MOUD treatment or non-MOUD-based treatment) accessed by individuals newly eligible for treatment through expansion. Based on official North Carolina statistics and published peer-reviewed literature, we developed a simulation model that forecasts opioid overdose and mortality under different scenarios for type of treatment accessed (MOUD-based vs. non-MOUD-based) and Medicaid coverage levels. An optimistic scenario assuming 70 % of individuals newly eligible for treatment would enter treatment during the first year of expansion estimated that 332 (Simulation Interval: 246-412) overdose deaths would be averted. A scenario more in line with recent historical trends assuming 38 % of individuals newly eligible for treatment would enter treatment resulted in 213 (Simulation Interval: 157-263) averted overdose deaths. In all scenarios, MOUD-based treatment approaches increased the number of lives saved compared with approaches expanding opioid treatment through non-MOUD-based treatment. Our study emphasized the need to ensure access to MOUD-based treatment for individuals newly covered by the Medicaid expansion.
摘要：
扩大医疗补助在确保美国人民获得医疗保健服务方面发挥着重要作用。尽管北卡罗来纳州最近开始扩大医疗补助计划，扩大对过量和过量死亡率的影响可能因治疗类型而异(提供阿片类药物使用障碍[MOUD]与提供住院医疗管理的停药，而不与进一步的MOUD治疗或非基于MOUD的治疗挂钩）通过扩展新符合条件的个人获得。根据北卡罗来纳州的官方统计数据和已发表的同行评审文献，我们开发了一个模拟模型，该模型预测了不同情况下接受治疗类型的阿片类药物过量和死亡率(基于MOUD的与非基于MOUD)和医疗补助覆盖水平。一个乐观的情况是，假设70%新符合治疗条件的个体将在扩张的第一年进入治疗，估计将避免332(模拟间隔:246-412)过量死亡。与最近的历史趋势更一致的情况是，假设新获得治疗资格的38％的个体将进入治疗，导致213（模拟间隔：157-263）避免了过量死亡。在所有情况下，与通过非基于MOUD的治疗扩大阿片类药物治疗的方法相比，基于MOUD的治疗方法增加了挽救的生命数量。我们的研究强调有必要确保医疗补助扩展新覆盖的个人获得基于MOUD的治疗。
