Market Level Correlates of Charity Care Provision in Substance Abuse Treatment Facilities

Research Objective : The purpose of this study was to identify the market factors that influence charity care provision in substance abuse treatment facilities located in the United States.

Study Design: The study is a cross-sectional study of SATFs located in 48 states in the United States. Data was obtained from the 2009 National Survey of Substance Abuse Treatment Services (N-SSATS) and analyzed using multivariate logistic regression. Charity care provision is measured as a binary variable. The market is defined at the level of the county. Market factors assessed in this study includes the number of SATFs in the county; rural or urban location; percent uninsured; population count; proportion of residents living in poverty and median income. The proportion of residents living in poverty and median income are examined as categorical variables. The study controls for facility level characteristics including licensed status, accredited status, affiliation with religious institution, total number of patients, receipt of earmarked public funds, and acceptance of Medicare, Medicaid or private insurance. Facilities receiving earmarked public funds are more likely to provide charity care. In addition, it is likely that facilities providing charity care may be selected to receive earmarks. The two step residual inclusion instrumental variable method was used to account for possible endogeneity in the earmark variable.

Population Studied : SATFs located in 48 states in the United States (N=9451).

Principal Findings : After controlling for facility-level factors, market level factors associated positively with the provision of charity care included proportion of residents living in poverty and percent uninsured. County-level population count, geographic location (rural/urban) and median income were not associated with charity care provision. Additionally, market competition (as measured by the number of SATFs in the county) was not significantly associated with charity care provision. Facility-level factors increasing the likelihood of charity care provision included affiliation with religious institution ; acceptance of Medicare and Medicaid and receipt of earmarked public funds .Forprofit status , accredited status and acceptance of private insurance were negatively associated with charity care provision in SATFs.

Conclusions : SATFs located in markets with greater economic need are more likely to provide charity care. Market competition does not appear to influence charity care provision among SATFs in the United States.

Implications for Policy, Delivery, or Practice : Organizational literature on substance abuse treatment facilities in the United States is lacking. This study attempts to fill a gap in literature by examining the environmental correlates of charity care provision in SATFs. Findings indicate that SATFs are responsive to the economic need of the environment within which they operate. Policymakers could target earmarked mental health funding to such facilities as a means of expanding access to mental health and substance abuse treatment services.