Economic and policy implications of early intervention in HIV disease

Article Abstract:

The authors call for early intervention in HIV (human immunodeficiency virus) disease and explore the impact of their proposals for expanded services on the US health care system. Ninety percent of the individuals currently infected with the HIV virus are omitted from the count of AIDS (acquired immunodeficiency syndrome) cases. The existing medical care system could not serve even a segment of this population of approximately one million asymptomatic (without symptoms) HIV carriers. To meet the needs of this group for counseling, medications, laboratory tests and general health care approximately five billion dollars would be required annually. Provision of such extensive resources could only be achieved with major commitments from all levels of government and the private sector. A coordinated, efficient network of ambulatory centers would be required. The medical foundation for initiating early intervention is growing. Biologic indicators that track the progression of HIV disease have been identified. Antiviral medications are showing promise of halting immune system deterioration. Scientists are learning how to prevent and control the most common opportunistic infection, Pneumocystis carinii pneumonia. The authors' rationale for launching early intervention strategies is three-fold. First, the history of HIV disease to date suggests that without early intervention, most infected individuals will develop end-stage AIDS. Second, there is evidence that certain medications can stop the virus from reproducing and could thereby reduce the rate of new HIV infections. Third, infections often linked to HIV, such as tuberculosis and pneumonia, may be more effectively treated if anti-HIV drugs are used in combination with conventional treatments. In summary, planning for expansion of health services to provide early intervention should begin immediately. The AIDS policies of the past nine years were created in crisis and must be replaced with efficient, rational strategies. Early intervention would provide society with a chance to influence the progression of this deadly epidemic.

Care and treatment, Medical care, HIV (Viruses), HIV, Medical care needs assessment, AIDS virus carriers, HIV carriers

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How many physicians can we afford?

Article Abstract:

A study is presented of projected trends in the number of physicians and their incomes, to help evaluate whether the US can afford its ever-increasing physician population. Data from the American Medical Association and the Health Care Financing Administration are used. Results indicate an expected increase in the physician-to-patient ratio between 1986 and 2000 of 22 percent (from 144 to 176 per 100,000). Three scenarios are described involving different rates of increase of physicians' incomes during these years: increases at the rates of the consumer price index (CPI), gross national product (GNP), or current trends. The projected overall costs under each scenario are calculated. Results show that physician costs could remain the same proportion of the GNP as they are now (about 2 percent), even with an increased physician/population ratio, if physician costs continue to rise at the rate of the CPI. If, however, these costs follow recent trends and increase faster than the CPI, expenditures for physicians could equal as much as three percent of the GNP. This becomes particularly problematic in light of the projected increase in the number of physicians: health care planners will be faced with a choice between holding down costs, and heeding more doctors' calls for more money. Recent history demonstrates that increased physician supply does not necessarily hold down physician costs. For their part, physicians face increasing practice costs, which could drive their net incomes to $64,300 in 2000, down more than $50,000 from 1986 levels (in 1986 dollars). Careful consideration concerning resource allocation in health care will be necessary in the coming years; whether the allocation of more and more resources to physicians is a deliberate or inadvertent choice, it still represents a choice of health care priorities. Another article on a related subject appears in the May 8, 1991 issue of The Journal of the American Medical Association. (Consumer Summary produced by Reliance Medical Information, Inc.)

Models, Evaluation, Supply and demand, Physicians, Medical professions, Medical care, Cost of, Health care costs, Control, Medical fees

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Advancing America's health

Article Abstract:

A five-component strategy devised by the U.S. Public Health Service may improve the health of Americans. The U.S. Public Health Service is attempting to reorganize the health care system and reorient it towards improving the health of the population. Public health services must be defined and strengthened through the provision of adequate funding. Government health agencies, health plans, health care providers and community organizations must pool their resources and engage in collaborative efforts to meet the needs of local communities. Investment is necessary to build an infrastructure of research, information systems, and training and workforce development. Responsible social policies that do not directly pertain to health deserve support because these policies may impact health status.

Standards, Management, Public health, United States. Public Health Service

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