Date of Conferral

2023

Degree

Ph.D.

School

Public Health

Advisor

Patrick Dunn

Abstract

Drug addiction, mental health disorders, and homelessness has impacted communities nationwide increasing mortality and morbidity and is a public health threat. But access to substance use treatment has been a problem due to the lack of the ability by many to pay for services. This observational quantitative research design utilized administrative secondary data collected between July 2017 and June 2022. The key variables are Insurance Status, Number of Admissions, and Successful Discharges in outpatient substance use treatment. The purpose of the study and research questions involved evaluating the effects Drug Medi-Cal (DMC) Organized Delivery System program by analyzing program admissions completion. The data set included 2679 who were admitted to treatment just before and 4 years after DMC implantation; there were 810 successful completers. Multinomial regression was used to examine relationship between admission, completion of treatment, and insurance status. Parallel mediation analysis addressed the impact of race and ethnicity as mediators of the relationship between insurance status and admissions and discharges by program implementation year. Results indicate that insurance coverage predicts numbers of treatment admissions and successful completions due to DMC in Years 3 and 4. Race (Indirect effect = -.0205, 95CI -.0360, -.0076) and Ethnicity (Indirect effect = .0490, 95CI .0281, .0725) were significant mediators for admissions, but not discharges. The DMC program appears to impact treatment seeking and completion. Implications for positive social change include increasing access to treatment for disadvantaged populations, thus resulting in improved quality of life and increased insurance parity.

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