Publicly owned outpatient substance use disorder treatment facilities are likely to accept Medicaid or offer services free of charge to vulnerable populations. However, some geographical areas have greater availability, and thus offer better access to public treatment facilities.
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Furthermore, cross-sectional research (e.g., data from a single time point) has shown that such facilities are less likely to be located in counties with a greater percentage of black residents. Little is known about changes over time in the substance use disorder treatment infrastructure and the implications for black communities.
This study identified changes in the location of substance use disorder treatment facilities from 2002-2010 that offered outpatient treatment and classified them by ownership status (public, private nonprofit, and private for profit) because public and nonprofit facilities are less likely to turn clients away based on their ability to pay and offer vital comprehensive services.
Last, the researchers examined whether the percentage of black residents in a county was associated with changes in the availability of these outpatient facilities.
This study merged and analyzed national data from two sources:
Next they determined if each county had a net gain in the number of outpatient facilities between 2002-2010, or a net loss, and if the gain or loss was associated with the racial composition of the county (e.g., percentage of black residents).
Among counties that had at least one public facility in 2002, nearly half experienced a net loss in the number of public facilities by 2010. Public facilities constituted only 15% of the sample at the beginning of the study.
This study highlights the importance of monitoring the geographical locations of substance use disorder treatment facilities, particularly according to ownership status and county demographics (e.g., racial composition) for equivalent access to care.
The decline in public substance use disorder facilitates for black communities has not been offset by an increase in private for profit or nonprofit facilities. This means that counties with high proportions of black residents are less likely to have geographical access to vital, affordable treatment resources.
It is important to note, that the statistical analysis (e.g., regression) indicated there was no significant association between county percentage of black residents and the likelihood of losing a public facility after adjusting for other county-level characteristics. This means that although counties with higher proportions of black residents were disproportionately affected by the decline in public substance use disorder facilities, racial composition doesn’t “explain” the variance over and above other county-level characteristics.
The county is a meaningful unit of analysis for health resource planning purposes and has been used to understand the distribution of outpatient health care resources for vulnerable populations; however, county sizes can vary considerably.
Future research should examine the availability of facilities using a more sensitive unit of analysis as data become available so a more direct inference can be made between the proportion of vulnerable residents (e.g., impoverished) and geographical access to substance use disorder treatment in a way that more closely mirrors their proximal geographical context. Specifically, the census-tract level of analysis has been shown to be particularly sensitive to socioeconomic gradients.
Cummings, J.R., Wen, H., & Ko, M. (2016). Decline in public substance use disorder treatment centers most serious in counties with high shares of black residents. Health Affairs, 35. 1036-1044
l
Furthermore, cross-sectional research (e.g., data from a single time point) has shown that such facilities are less likely to be located in counties with a greater percentage of black residents. Little is known about changes over time in the substance use disorder treatment infrastructure and the implications for black communities.
This study identified changes in the location of substance use disorder treatment facilities from 2002-2010 that offered outpatient treatment and classified them by ownership status (public, private nonprofit, and private for profit) because public and nonprofit facilities are less likely to turn clients away based on their ability to pay and offer vital comprehensive services.
Last, the researchers examined whether the percentage of black residents in a county was associated with changes in the availability of these outpatient facilities.
This study merged and analyzed national data from two sources:
Next they determined if each county had a net gain in the number of outpatient facilities between 2002-2010, or a net loss, and if the gain or loss was associated with the racial composition of the county (e.g., percentage of black residents).
Among counties that had at least one public facility in 2002, nearly half experienced a net loss in the number of public facilities by 2010. Public facilities constituted only 15% of the sample at the beginning of the study.
This study highlights the importance of monitoring the geographical locations of substance use disorder treatment facilities, particularly according to ownership status and county demographics (e.g., racial composition) for equivalent access to care.
The decline in public substance use disorder facilitates for black communities has not been offset by an increase in private for profit or nonprofit facilities. This means that counties with high proportions of black residents are less likely to have geographical access to vital, affordable treatment resources.
It is important to note, that the statistical analysis (e.g., regression) indicated there was no significant association between county percentage of black residents and the likelihood of losing a public facility after adjusting for other county-level characteristics. This means that although counties with higher proportions of black residents were disproportionately affected by the decline in public substance use disorder facilities, racial composition doesn’t “explain” the variance over and above other county-level characteristics.
The county is a meaningful unit of analysis for health resource planning purposes and has been used to understand the distribution of outpatient health care resources for vulnerable populations; however, county sizes can vary considerably.
Future research should examine the availability of facilities using a more sensitive unit of analysis as data become available so a more direct inference can be made between the proportion of vulnerable residents (e.g., impoverished) and geographical access to substance use disorder treatment in a way that more closely mirrors their proximal geographical context. Specifically, the census-tract level of analysis has been shown to be particularly sensitive to socioeconomic gradients.
Cummings, J.R., Wen, H., & Ko, M. (2016). Decline in public substance use disorder treatment centers most serious in counties with high shares of black residents. Health Affairs, 35. 1036-1044
l
Furthermore, cross-sectional research (e.g., data from a single time point) has shown that such facilities are less likely to be located in counties with a greater percentage of black residents. Little is known about changes over time in the substance use disorder treatment infrastructure and the implications for black communities.
This study identified changes in the location of substance use disorder treatment facilities from 2002-2010 that offered outpatient treatment and classified them by ownership status (public, private nonprofit, and private for profit) because public and nonprofit facilities are less likely to turn clients away based on their ability to pay and offer vital comprehensive services.
Last, the researchers examined whether the percentage of black residents in a county was associated with changes in the availability of these outpatient facilities.
This study merged and analyzed national data from two sources:
Next they determined if each county had a net gain in the number of outpatient facilities between 2002-2010, or a net loss, and if the gain or loss was associated with the racial composition of the county (e.g., percentage of black residents).
Among counties that had at least one public facility in 2002, nearly half experienced a net loss in the number of public facilities by 2010. Public facilities constituted only 15% of the sample at the beginning of the study.
This study highlights the importance of monitoring the geographical locations of substance use disorder treatment facilities, particularly according to ownership status and county demographics (e.g., racial composition) for equivalent access to care.
The decline in public substance use disorder facilitates for black communities has not been offset by an increase in private for profit or nonprofit facilities. This means that counties with high proportions of black residents are less likely to have geographical access to vital, affordable treatment resources.
It is important to note, that the statistical analysis (e.g., regression) indicated there was no significant association between county percentage of black residents and the likelihood of losing a public facility after adjusting for other county-level characteristics. This means that although counties with higher proportions of black residents were disproportionately affected by the decline in public substance use disorder facilities, racial composition doesn’t “explain” the variance over and above other county-level characteristics.
The county is a meaningful unit of analysis for health resource planning purposes and has been used to understand the distribution of outpatient health care resources for vulnerable populations; however, county sizes can vary considerably.
Future research should examine the availability of facilities using a more sensitive unit of analysis as data become available so a more direct inference can be made between the proportion of vulnerable residents (e.g., impoverished) and geographical access to substance use disorder treatment in a way that more closely mirrors their proximal geographical context. Specifically, the census-tract level of analysis has been shown to be particularly sensitive to socioeconomic gradients.
Cummings, J.R., Wen, H., & Ko, M. (2016). Decline in public substance use disorder treatment centers most serious in counties with high shares of black residents. Health Affairs, 35. 1036-1044
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