Date of Award


Degree Name

Doctor of Philosophy


Public Affairs and Administration

First Advisor

Dr. Helenan Robin


In an attempt to slow and reduce this nation's costs for alcoholism services under the Medicare and Medicaid programs, the Health Care Financing Administration and the National Institute on Alcoholism and Alcohol Abuse in 1981 collaborated and jointly developed the Alcoholism Services Demonstration (ASD). The major project goal of the Alcoholism Services Demonstration was to demonstrate that cost savings could be derived by providing alcoholism services to Medicare- and Medicaid-eligible recipients in freestanding alcohol treatment centers.

The purpose of this research was to evaluate Michigan's experience under the national demonstration project with a major focus on the following questions: (a) Did the provision of alcoholism treatment result in a subsequent reduction in total health care expenditures for Michigan Medicaid recipients? and (b) Was there a difference in Medicaid costs among recipients treated for alcoholism in the acute care inpatient hospital setting versus the freestanding demonstration setting?

The research design chosen was a quasi-experimental time series analysis using a nonequivalent control group. The data used were Medicaid-reimbursed total health care claims for the entire alcohol treated Medicaid population over a 36-month period. The original study design was to compare the Medicaid costs between the inpatient-hospital-treated recipient and the demonstration-treated recipient. However, a third comparison group was added when it was found that a number of recipients used both treatment settings during the study period.

Multiple classification analysis was selected as the statistical technique in this research because it enabled the researcher to compute means for the dependent variable (adjusted average quarterly Medicaid costs) for each treatment setting while controlling for other independent variables (age, race, gender, and county of residence).

The findings of this research showed that none of the alcoholism treatment provided in the various treatment settings reduced subsequent total health care costs and that alcoholism treatment provided in the demonstration setting was less costly than the alcoholism treatment provided in the acute care inpatient hospital setting.

A secondary finding was that a significant portion of the alcoholism-treated Medicaid population used the various treatment-setting options at will due to the state's inability to mandate specific treatment providers for Medicaid recipients.

Access Setting

Dissertation-Open Access