The American Academy of Pediatrics (AAP) recognizes the impact of substance abuse on society and particularly on infants, children, and adolescents. Policy statements and a manual published by the AAP have recently discussed the role of the pediatrician in the management of substance abuse,1,2 the identification and treatment of drug-exposed infants,3 and generic guidelines for the selection of substance abuse treatment facilities.4 Inadequate financing, however, remains a very significant impediment to the implementation of AAP policy and often has grave implications for families and children.

PROBLEMS IN FINANCING SERVICES FOR SUBSTANCE ABUSE

Private and public financing of chronic disease services, including those involved with substance abuse services are conflicting, confusing, and inadequate for children and adolescents. The following four main problems occur: 1) many children and adolescents, even if they are well-insured for other medical services, lack coverage for substance abuse services; 2) even when substance abuse coverage exists, copayments and deductibles make access difficult; 3) reimbursement often partially covers treatment but not prevention; and 4) services are not continuous or coordinated because of financing difficulties.

Patients are often treated for substance abuse in inpatient settings unnecessarily because of the limitations of financial coverage for outpatient substance abuse services.5 These limitations increase patient reliance on public financing. The provision of comprehensive services, including anticipatory guidance and prevention, risk assessment, early diagnostic evaluation, treatment, and follow-up care, is seldom consistent or continuous. As a result, health care providers are frequently pressured into recommending inappropriate levels of care based on third-party payer reimbursement considerations rather than on medical and psychosocial assessment and needs.

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