Medical and Insurance Options Essay

In the general medical practice, individuals with substance abuse disorders are common among people from all socioeconomic groups. The role of the primary care professionals is to make an initial diagnosis and treat these problems. The physician can be influential in getting the patient to accept treatment especially in a situation where the physician is empathic without being judgmental towards the patient. Primary care physicians are crucial in assisting the patients in doing away with chronic substance abuse, relapses of substances abuse and helping the patient not to see exacerbations as a failure but as a tool to intensify treatment. Primary care physician plays a role in recognition of substance abuse, gives guidelines for treatment of intoxication, techniques for intervention, long-term care of patients abusing substances, and withdrawal strategy from substances such as hallucinogens, sedatives, volatile inhalants, and opioids.

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The Primary care physician plays an increasingly essential part in the care of a patient who is dependent on harmful substances regardless of the person who referred the person with substance abuse disorder. It is impossible to avoid patients who are dependent on substances in modern medicine, thus long-term treatment of such people can be challenging, frustrating and at the same time a rewarding process for primary care physicians. They are customarily the first healthcare professionals to be aware of the disorder, a relapse and assist in referring a patient for treatment. These professionals are usually guardians trusted with the well-being of the patient and hence is concerned about the patient staying in remission from substance abuse. A primary care physician helps a person with substance abuse disorder to withdraw or recommend any other medical treatment for substance abuse especially in communities where there are limited resources for specialized treatment or the physicians are not available.

Primary care physicians are helpful in recognizing the substance abuser. Sometimes, a patient presents himself or herself in hospital or substance abuse disorders treatment centers with a formal request to withdraw entirely substance abuse. The physician should seize this opportunity to initiate treatment or refer the patient to an appropriate treatment program. Also, the primary care physician screens the patient for hypertension and diabetes mellitus as well as analyzing the change in behavior.

A primary care physician recognizes substance abuse disorder and helps the patient to resolve denial because substance abuse puts the users in a position where they are still attracted to the addictive behavior, want to continue abusing substances and at the same time do want to stop but are not exactly sure about what to do. Some cannot even admit the substance abuse disorder and conceal it from family, physician and friends. The primary care physician assists such a person by helping the patient to make informed decisions in stopping substance abuse and move toward change through motivational interviewing where the change arises from within the patient. Furthermore, relapse prevention, withdrawal from dependence, overdose prevention, reduced substance use, and prevention of overdose are all reasonable goals that the primary care physician plays in fighting substance use disorders (Lee, Kresina, Campopiano, Lubran & Clark, 2015).

Despite the expanding awareness on the significance of substance abuse education on disorders caused by substance dependence, there are limitations faced by the physician in diagnosing and treating substance disorders. For instance, the deficit in clinical skills and knowledge among primary care physicians in training and those already in practice result in negative attitude towards abusers. Polydorou, Gunderson and Levin (2008) argue that lack of faculty expertise, inadequate curriculum learning, and exposure to end-stage abuse of substances are contributory factors to negative attitudes among physicians. There is a need for resident practice habits improvement because residents have failed to adequately screen, diagnose and treat disorders caused by substance abuse. Practising physicians, therefore, have inadequately addressed substance abuse disorders based on the report given by the patient, medical record charting and the report received by the physician (Polydorou, Gunderson & Levin, 2008). This provides leeway for misdiagnosis of substance disorder, inadequate address of substance abuse by the primary care physician and lack of preparedness in the identification of alcohol or dependence on harmful substances.

Before 2013, there were millions of Americans who were without health insurance coverage and approximately 25 percent of these had either substance abuse disorders or mental health conditions or both (Henderson, 2014). The Affordable Care Act was introduced to achieve parity and thus efficiently covered a large number of people who else would not be covered. These people include those suffering from mental health issues and substance abuse disorders. To achieve parity, the Affordable Care Act provides one of the most significant increase in covering substance use disorder and mental health in the United States.

This means that market plans and new small groups will be essential to cover ten categories of Essential Health Benefit which includes mental health and substance use disorder services, which covers them at parity with surgical and mental benefits (Wen, Cummings, Hockenberry, Gaydos & Druss, 2013). This requirement is demanded from insurers and group health plans that offer substance use disorder and mental health benefits to make coverage available and comparable to those offered for surgical and medical care. Despite the fact that small and large groups plans include coverage for substance use disorders and mental health services, there is inequality because some people do not receive federal parity protections.

Some of the changes that were introduced include the implementation of the final rule of implementing the Essential Health Benefits. There is a direction that non-grandfathered health plans in the small and individual group markets must provide coverage for substance use disorders and mental health and also conform to the requirements of the federal parity law.

This, therefore, means that people living with mental health and substance abuse disorders are going to get an expanded coverage and are under the federal parity protections. Because of this, they will get assistance from the Essential Health Benefits, and thus more Americans will be provided with access to quality health that covers people suffering from mental health and substance abuse disorders.

Lastly, Affordable Care Act has led to improved medical access for people with mental health and substance abuse disorders as it has expanded medical insurance to approximately 21 million people through coverage subsidies, Medicaid expansions and insurance reforms (Timby & Smith, 2013). The number of uninsured adults has decreased drastically while the number of people who can access mental health treatment and substance abuse disorder services has increased. Sherrill and Gonzales (2017) notes that after the passage of the Affordable Care Act, there was a marked reduction in the number of uninsured adults with no mental health and a significant drop in those with severe and moderate mental illness.

References

Henderson, J. W. (2012). Health Economics and Policy (With Economic Applications). Cengage Learning.

Lee, J., Kresina, T. F., Campopiano, M., Lubran, R., & Clark, H. W. (2015). Use of pharmacotherapies in the treatment of alcohol use disorders and opioid dependence in primary care. BioMed research international, 2015.

Polydorou, S., Gunderson, E. W., & Levin, F. R. (2008). Training physicians to treat substance use disorders. Current psychiatry reports, 10(5), 399-404.

Sherrill, E., & Gonzales, G. (2017). Recent Changes in Health Insurance Coverage and Access to Care by Mental Health Status, 2012-2015. JAMA psychiatry, 74(10), 1076-1079.

Timby, B. K., & Smith, N. E. (2013). Introductory Medical-Surgical Nursing. Lippincott Williams & Wilkins.

Wen, H., Cummings, J. R., Hockenberry, J. M., Gaydos, L. M., & Druss, B. G. (2013). State parity laws and access to treatment for substance use disorder in the United States: implications for federal parity legislation. JAMA Psychiatry, 70(12), 1355-1362.