TREAT 'EM: Triangulation, Risk, and the Economics of Alcoholism and Treatment among Elders in Medicare

This dissertation is divided into three distinct, but related studies on alcoholism among elderly persons. The purpose of the first study was to triangulate between two large, secondary data sources to determine the risk factors for both diagnosed and self-reported alcoholism. Claims data from the Medicare Current Beneficiary Survey were used to examine individuals with diagnosed alcoholism and survey responses to the CAGE questions in the Health and Retirement Study were used to examine individuals with self-reported alcoholism. The results of study one suggest that less than half of individuals who self-report would be diagnosed (4.31% versus 1.87%, respectively), and some groups may be at particularly high risk of under-diagnosis. The purpose of the second study was to examine factors associated with alcohol treatment among a sample of 390 elderly Medicare beneficiaries already diagnosed with alcoholism and to produce cost estimates for alcohol treatment. A generalized linear model with a gamma distribution and log link was used to estimate treatment costs in the 12 months following diagnosis. The results of study two suggest that about half (52.6%) of elderly individuals diagnosed with alcoholism receive any treatment for alcoholism, and certain groups of diagnosed elderly may be at high risk of under-treatment. The cost of alcohol treatment for individuals diagnosed with alcoholism is $9,714.16 per year. The purpose of the third study was to test the cost-offset hypothesis, (a phenomenon where treatment for alcohol problems reduces the use of medical services), using five years of claims data from the Medicare Current Beneficiary Survey. Two distinct methodological approaches, propensity scoring and difference-in-differences, were used to estimate treatment effects. Although insufficient power likely limited my ability to detect significant differences, the results of this study are encouraging and warrant further study of larger samples over longer periods of time. Taken together, the results of this research particularly highlight the need for targeted interventions to increase detection of those not yet diagnosed and treatment seeking among those already diagnosed with alcoholism. Such interventions may reduce the need for subsequent medical hospitalizations caused by the complications of alcoholism, especially among those with acute onset.

Health care

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