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Choice of hospital, not just insurance status, determines care received by people with HIV

Privately insured patients who are infected with the human immunodeficiency virus (HIV) that causes AIDS are nearly twice as likely to be admitted to private hospitals as uninsured and Medicaid-insured patients. This hospital selection, not merely insurance status, affects the intensity of care they receive, according to a recent study led by Geoffrey F. Joyce, Ph.D., of the RAND Health Sciences Program. The study was supported in part by the Agency for Health Care Policy and Research (NRSA training grant T32 HS00046).

The researchers analyzed patient data linked to billing records from AHCPR's AIDS Cost and Service Utilization Survey (ACSUS). They studied the inpatient and outpatient care of 1,900 adults and adolescents at various stages of HIV disease in 10 U.S. cities with a high incidence of AIDS. Privately insured patients were more apt to be admitted to private hospitals than Medicaid patients who, in turn, were nearly twice as likely to be admitted as were uninsured patients and those covered by other public programs.

A considerable portion of hospital care resources used—such as laboratory tests and treatments—was accounted for by the hospital in which the patient was admitted. For example, patients covered by Medicaid or "other insurance" had 27 percent to 41 percent lower charges (indicating fewer care services) than similarly ill patients with private insurance. Yet controlling for site of care reduced the impact of insurance by roughly two-thirds. Despite the importance of hospital-specific factors, the authors could not conclude that insurance did not matter because modest differences in resource use persisted even after controlling for the hospital in which care was received.

More details are in "Variation in inpatient resource use in the treatment of HIV: Do the privately insured receive more care?" by Dr. Joyce, Dana P. Goldman, Ph.D., Arleen Leibowitz, Ph.D., and others, in Medical Care 37(3), pp. 220-227, 1999.

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