Receipt of Earmarks and the Provision of Charity Care in Substance Abuse Treatment Facilities

Background: Mental health and substance abuse treatment facilities receive earmarked public funds to expand mental health and substance abuse treatment services. The aims of this study are to examine the association between the receipt of earmarks and provision of charity care in substance abuse treatment facilities (SATFs) and to assess if this association is modified by ownership type.

Methods: This is a cross-sectional study of 9735 SATFs 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.

Results: Compared to facilities not receiving earmarks, facilities receiving earmarks were 3.06 times more likely to provide charity care (p<0.001). There was no interaction between ownership type and receipt of earmarks (p =0.320). Organizational factors increasing the likelihood of charity care provision included affiliation with religious institution (OR = 1.44 p<0.001); acceptance of Medicaid (OR = 1.24, p<0.001); acceptance of Medicare (OR = 1.14, p=0.025) and licensed status (OR = 1.14, p=0.009). For-profit status (OR = 0.33; p<0.001), accredited status (OR =0.84; p<0.001), hospital affiliation (OR = 0.74; p =0.001) and acceptance of private insurance (OR =0.67; p <0.001) decreased the likelihood of providing charity care. Rural location was not associated with the provision of charity care.

Conclusions: Findings suggest that awarding earmarks to substance abuse treatment facilities may be an effective means of expanding community access to mental health services.