Paying the medical cost of the HIV epidemic: a review of policy options

Article Abstract:

The average lifetime cost of treatment for an AIDS patient is estimated at $62,000 to $94,000. For 1991, the projected cost of medical care for all patients with AIDS in the United States is estimated at $8.5 billion. If the spread of infection cannot be controlled, the cost will be much higher in future years. Although many of the problems of financing care for AIDS patients are similar to those of providing for other health care, there are certain features which make financing for AIDS different. Individuals with AIDS are more likely to be uninsured or to receive Medicaid benefits than the general population. Many of the people with AIDS are intravenous drug users, who are usually unemployed, or if employed often do not have medical benefits. Many of those with AIDS do not have support or financial assistance from their families. Medical insurance often does not include all the care that is necessary on a inpatient, outpatient or at-home basis. As a result, much of the care for AIDS patients is given in the hospital, which increases costs. There are no allowances provided to the hospitals for additional costs that are required to care for AIDS patients, such as safety measures necessary to protect employees. To be eligible for Medicaid, individuals with AIDS must be below the poverty level and be disabled. There is a growing number of individuals that are infected with HIV but do not have AIDS, and thus are not eligible for Medicaid. The authors conclude that two improvements should be made: (1) changes in reimbursement policies, and (2) availability of heath care insurance for everyone. The reimbursement policy should provide care in a cost-sensitive way. Reimbursement must include home care and community-based care. Case-management programs, which evaluate the care that is needed and then determine how this care can be provided at the lowest cost, are needed. Persons without health insurance should have health benefits; one way to accomplish this is a comprehensive national health care financing system. Other ways to accomplish this goal are discussed. (Consumer Summary produced by Reliance Medical Information, Inc.)

Analysis, Reports, Health insurance, Medicaid, Medical case management

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The costs of AIDS in Los Angeles

Article Abstract:

A report was complied on the costs of health care for 36 patients with AIDS who lived in Los Angeles, California and received care during 1987 and 1988. The costs considered in the report included medical and nonmedical services. The average number of times the patients were hospitalized was 1.6 times per year, with 17 days of hospital care. The average costs for the first year after diagnosis were $22,272 for inpatient hospital care and $22,850 for outpatient care, with the overall medical costs averaging $45,122 per year. Lifetime costs were estimated to be from $50,000 to $60,000, and were based on the average life expectancy for patients with AIDS of 13 to 15 months. Approximately one-third of the costs were for drugs, including zidovudine (AZT), which is used to control HIV infection, and aerosolized pentamidine, which is used to prevent pneumonia due to Pneumocystis carinii. The average cost for nonmedical services, such as volunteer services and counselling, was $9,276. The health care costs for AIDs patients in the Los Angeles area were similar to those in other regions of the United States. This study suggests that a large portion of future costs will come from outpatient services and drug treatment. Because many of the newly discovered drug therapies are not covered by health insurance, a large majority of these costs will be passed on to the patients themselves. Since there has been a shift in the treatment of patients with AIDS from hospital-based care to outpatient care, and since new drug regimens are being used, there is a need for policy changes that will lower the financial burden on the patients. (Consumer Summary produced by Reliance Medical Information, Inc.)

Drugs, California, Los Angeles, California

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Intensity of in-hospital care for persons with AIDS

Article Abstract:

Because the number of individuals with HIV infection is increasing, the costs of medical care for patients with this disease will be very high. Studies have shown that the best way to reduce costs is for hospital facilities to be used optimally. Certain types of care can be given on an out-patient basis or at other facilities that provide skilled nursing care. A study examining the medical care of 30 AIDS patients at one hospital showed that more than half the patients had one 'delay' day when they could have been treated at another facility. The major reasons why care was not given at alternative sites included: difficulty placing patients in facilities with skilled nurses (20 percent of the cases); difficulty coordinating out-of-hospital care (28 percent); and difficulty in scheduling outpatient surgery (12 percent of the cases). In half the cases, seven days or more of hospital care could have been avoided if there was better coordination with out-patient care programs and increased availability of facilities with skilled nursing. Five of the 30 patients died in the hospital after lengthy hospitalizations (averaging five weeks). Large amounts of resources were used in their care, most of which could have been provided at a hospice facility or a facility with skilled nursing care. Greater availability and proper management of home care programs, skilled nursing facilities, psychiatry facilities, and hospices are needed so that patients with AIDS may receive improved quality of care, and experience better quality of life while assuring that funds for health care are spent wisely. (Consumer Summary produced by Reliance Medical Information, Inc.)

Prices and rates, Hospitals, Hospitalization, Home care, Hospital rates

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