Ownership, public policy, and market conditions: Their effect on the provision of support services in outpatient substance abuse treatment

This study examines in two ways the provision of support services in outpatient substance abuse treatment (OSAT): (1) the extent to which ownership makes a difference; (2) how public policy and market conditions influence the ownership effect. Two types of support services are investigated: free treatment provision and the total number of ancillary services helping underserved populations recover from drug and alcohol abuse. Regression results suggest that nonprofit OSATs are more likely to offer free treatment and provide a wider range of ancillary services than for-profit OSATs controlling other OSAT characteristics and external conditions. Free treatment provision by nonprofits is twice as high as it is by for-profits. The number of ancillary services is 33% higher in nonprofit facilities than in for-profit facilities. Nonprofit organizations in the outpatient substance abuse treatment area perform their fundamental role serving medically, socially, and economically disadvantaged populations. At the same time, findings of the study show that public policy and market conditions moderate the ownership effect. Government funding, characteristics of states' parity legislations, market competition with for-profit organizations, and demand for public services impact nonprofit OSATs' support service provision. Each ownership responses to given policy and market conditions in different ways. This study contributes to the field by showing that ownership difference is evident in types of services offered and the level of support for disadvantaged patients. It is also a valuable addition to the literature about ownership difference in health care research. Ownership difference can better be explained by understanding interactions between ownership and external conditions such as policy and market factors. Given rising interest in comprehensive care and a wraparound approach coordinating behavioral health services with housing, employment, education, and other supports. The findings of this study provide policy makers and practitioners with valuable information about factors related to OSAT provision of support services. Future research will be directed toward the dynamics of ownership and policy interactions and the impact of the recent health care reforms on OSAT support provision.