Providers With Private Funding Exclusively, 1980-92

The NDATUS survey requests data on provider funding by source. Often these questions are not answered or the data appear questionable. However, it is possible to identify a subset of respondents that receive only private funds. This distinction is important because these providers do not rely on public funds and thus they exclude potential clients except those who have private insurance or high personal income. The NDATUS data can be used to partially assess whether this exclusion results in different patterns of treatment services utilization.

Capacity Utilization

Treatment capacity is defined by NDATUS as the number of clients that could have been in treatment on the census day, given immediately available resources. Capacity utilization equals clients in treatment on the census day divided by this capacity.

• In both outpatient and 24-hour rehabilitation services, providers receiving only private funds reported lower utilization of capacity than the national average. Privately funded providers utilized 70% of their outpatient rehabilitation capacity and 58% of 24-hour rehabilitation capacity, compared to the U.S. average (mostly publicly funded) of 80% and 76% respectively. This finding may suggest that it was generally easier for clients to enter specialty treatment on a given day if they could pay for it with private insurance, personal income, or other non-government funds.

• Caveat. Capacity utilization varied widely among the States. For outpatient, 4 States (Connecticut, Louisiana, Utah, and West Virginia) and Puerto Rico reported rates greater than 90%. On the other extreme, 6 States (Hawaii, Minnesota, Nevada, North Dakota, Oklahoma, and South Dakota) reported that less than 70% of outpatient capacity was in use. For 24-hour rehabilitation, 4 States (Alabama, Connecticut, New York, and Oregon) reported capacity utilization greater than 85%. On the other extreme, 4 States (Idaho, Montana, North Dakota, and Wyoming) reported utilization less than 60%.

Clients in Specialty Substance Abuse Treatment by Type of Treatment

All providers                 Clients    Capacity    Utilization rate
   Outpatient                 822,941    1,031,194         79.8

   Rehabilitation 
      (24-hr care)            107,026      140,178         76.4

   Detoxification 
      (24-hr care              14,912       26,275         56.8
   Total                      944,880    1,197,647         78.9

Private funding only
   Outpatient                 154,032      220,825         69.8

   Rehabilitation
      (24-hr care)             11,927       20,419         58.4
   Detoxification (24-hr care)  3,318        5,504         60.3
   Total                      169,278      246,748         68.6

Capacity can be difficult to define in other than stand-alone residential facilities, where capacity equals the number of beds. Outpatient treatment capacity can quickly stretch by shortening treatment sessions, increasing staff caseloads, or by hiring space and staff. Hospital inpatient capacity may also change easily by shifting general purpose beds from one diagnosis to another.

Capacity utilization in NDATUS indicates the extent to which capacity is held in reserve to meet fluctuations in demand; the lower utilization, the higher the reserve. When reserves are relatively high, it may also indicate failure to reduce capacity in response to limited demand for services.

A high rate of capacity utilization, measured by this one-day census, may or may not imply that capacity is a major factor limiting access to treatment. Even if capacity utilization is high, the main reason more clients are not in treatment could be the lack of funds to pay for services. Should funding increase substantially, treatment capacity may be able to expand right along with it.

Client Demographics

• Since 1980, the subset of facilities reporting only private funds consistently reported a higher proportion of men in treatment than the national average, and a higher proportion of white and Hispanic clients. Conversely, they served lower proportions of women and black clients.

All Providers vs. Providers Receiving Private Funds Only: Client Sex

                             Percent

Men                  1980   1982   1987   1989   1990   1991   1992
   All providers     74.8   74.8   72.3   70.4   72.1   72.5   71.1
   Private funding
     only            78.9   78.8   76.4   75.5   78.4   78.9   78.5

Women
   All providers     25.2   25.2   27.7   29.6   27.9   27.5   28.9
   Private funding 
     only            21.1   21.2   23.6   24.5   21.6   21.1   21.5

All Providers vs. Providers Receiving Private Funds Only: Client Race/Ethnicity

                                          Percent
                       1980   1982   1987   1989   1990   1991   1992
White, non-Hispanic

   All providers       62.7   64.2   65.6   62.6   61.8   61.5   59.8
   Private funding
     only              66.9   73.5   69.0   67.4   65.0   63.4   64.4

Black, non-Hispanic

   All providers       20.6   20.5   19.4   20.6   20.7   21.2   21.6
   Private funding
     only              10.4    9.1   13.1   13.2   10.4   11.0   10.4

Hispanic

   All providers       13.4   12.3   12.4   13.8   14.4   14.1   14.6
   Private funding
     only              21.1   15.3   15.8   17.0   21.8   21.9   22.0

24-Hour Vs. Outpatient Rehabilitation

• Between 1980 and 1992, the proportion of outpatient clients over all providers increased, but the subset of providers using private funds exclusively made this shift more rapidly. In 1980, privately funded facilities were below the average in their proportion of outpatient clients (80% vs 84%), but by 1992 they were above the average (91% vs 87%).

All Providers vs. Providers Receiving Private Funds Only: Treatment Category

                                          Percent
                       1980   1982   1987   1989   1990   1991   1992
Outpatient

   All providers       84.1   83.7   85.5   85.8   87.8   87.8   87.1
   Private funding
     only              80.4   81.5   84.5   88.4   93.3   94.2   91.0

Rehabilitation (24-hr care)

   All providers       13.3   13.4   12.0   12.0   10.7   10.8   11.3
   Private funding 
     only              15.1   15.4   13.3   10.1    5.9    4.9    7.0

Detoxification (24-hr care)

   All providers        2.7    2.9    2.5    2.2    1.6    1.4     1.6
   Private funding
     only               4.5    3.1    2.2    1.5    0.8    0.9     2.0

This more rapid switch to outpatient care by providers using only private funds may reflect a number factors, including more rapid adoption of managed care by the private sector or the diversion of the most severely disabled clients to the public sector.

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