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The inpatient utilization and costs by persons living with HIV in 2000 is compared with inpatient utilization and costs in 2004. It is found that the average number of admissions per person living with HIV has fallen, but hospitalized patients living with HIV are getting older and sicker.

Twenty-eight states have laws that limit payments in malpractice cases, and several studies indicate that these laws reduce the frequency and severity of malpractice claims and lower premiums. Moreover, proponents believe that such laws reduce health care expenditures by reducing the practice of defensive medicine. However, there is a dearth of empirical evidence about the impact of these laws on the cost of health care. We used multivariate models and relatively recent data to estimate the impact of state tort reform laws that directly limit malpractice damage payments on health care expenditures. Estimates from these models suggest that laws limiting malpractice payments lower state health care expenditures by between 3% and 4%.

The federal Employee Retirement Income Security Act of 1974 (ERISA) supersedes state laws as they relate to employer-based health care plans. Thus, cases brought under ERISA are heard in federal courts. We examined time intent, scope, and impact of recent laws passed in 10 states attempting to expand the legal rights of health plan enrollees to sue their plans. In June 2004, the US Supreme Court ruled that state law causes of action brought under the Texas Health Care Liability Act involving coverage decisions by Aetna Health Inc and CIGNA Health Care of Texas were preempted by ERISA. The full implications of this decision are not evident at present. (Am J Public Health. 2005;95:217-223, doi: 10.2105/ AJPH.2004.037895)

A study is done to examine whether demographic disparities in the use of highly active antiretroviral therapy (HAART) persist in 2001 and if outpatient care is associated with HAART utilization. An attempt to increase access to care and frequency of outpatient visits for underutilizing groups as well as increased efforts to reduce persistent disparities in women, African Americans and injection drug users was suggested.

The authors examine trends in HIV-related inpatient admission rates and stay lengths from 1993 to 1997. Results demonstrate the decline in HIV-related hospital admission rates.

In 1996, between $6.7 billion and $7.8 billion was spent treating HIV infection in the US. The average cost of treating individual patients ranged from $20,000 to $24,700 annually.

The growth of managed care organizations has prompted many states to pass laws regulating these organizations. Such laws include direct-access laws, laws that prohibit exclusivity clauses and laws covering minimum hospital stays. Direct-access laws allow consumers to choose a specialist without a referral from their primary care physician. Fourteen states have passed this law, including those with the highest concentration of HMOs. Twenty-two states have passed laws mandating minimum hospital stays following childbirth. Many of the laws were passed without evidence of their potential effect on managed care organizations.

Health maintenance organizations (HMO) and preferred provider organizations (PPO) attract more enrollees who are healthy among the nonelderly population. A study of the persons who seek care from providers suggest that selection effects determined whether individuals will enroll in an HMO or PPO. It was shown that individuals who declined 'first-time-offers' to join provider organizations were most likely to enroll at the next possible opportunity. It was also shown that HMOs and PPOs that have good reputations experience favorable selection among both nonelderly and elderly enrollees.

Lower usage of inpatient hospital services may have decreased the lifetime cost of treating individuals with HIV infection. Researchers interviewed 1,164 HIV patients from 10 cities in spring and early summer of 1992. The monthly cost of treating HIV patients during the four stages of the disease. The estimated lifetime treatment cost was about $119,000 for the period from HIV infection until death. The estimated cost of treatment was $50,000 for the time between HIV infection and development of AIDS. Between the development of AIDS and death, the estimated cost of treatment was $69,000. The estimated cost of treatment between the diagnosis of AIDS and death was lower than predicted for 1992. AIDS patients may using be outpatient services more often than in the past., Objective. - To estimate the cost (total charges for services) of medical care for persons with human immunodeficiency virus (HIV) from the time of infection until death. Design and Setting. - Data from the AIDS (acquired immunodeficiency syndrome) Cost and Service Utilization Survey were used. Patients. - Data from interviews conducted during the spring and early summer of 1992 with 1164 respondents with HIV were analyzed. The respondents were recruited at 26 sites (hospitals, clinics, and physicians' offices) in 10 cities. Billing data from a survey of providers also were used. Outcome Measures. - Estimates of the mean occupancy time in each of four disease stages were obtained from the San Francisco Men's Health Study. These estimates were multiplied by the monthly cost in each stage and summed to derive a synthetic estimate of the lifetime medical care costs of treating a person with HIV. Results. - It is estimated herein that the lifetime costs of treating a person with HIV from the time of infection until death is approximately $119 000. The estimated cost of care from HIV infection until the development of AIDS is $50 000, while the estimated cost from AIDS development until death is approximately $69 000. These estimates define upper bounds because they assume persons receive treatment continuously from the moment of infection until death. Conclusions. - This study found that the cost of treating a person with AIDS, which has risen rapidly in the past, has fallen as a result of a reduction in the use of inpatient hospital services.

This study concludes that the cumulative (national) cost of treating all persons with the human immunodeficiency virus (HIV) rose considerably over the past year and will continue to rise over the next several years. It is forecast that the cumulative cost of treating all persons with HIV will increase 48% from 1992 to 1995 (from $10.3 billion to $15.2 billion). It is estimated that the average yearly cost of treating a person with AIDS is $38,300 and of treating an infected person without AIDS is $10,000. The lifetime cost of treating a PWA is calculated to be $102,000. This is the first study to use, along with other data, data from the AIDS Cost and Service Utilization Survey to estimate the cost of treating persons with the HIV. The study also projects the number of AIDS cases to be 66,300 in 1992, 76,200 in 1993, 86,800 in 1994, and 97,800 in 1995.

This is the first paper to forecast the cost of medical care for all people with the human immunodeficiency virus (HIV). Previous studies have concentrated on the cost of treating people with AIDS (PWAs). It is estimated that the average cost of treating a person with HIV without AIDS is $5,150 per year, and that the average cost of treating a PWA is $32,000 per year ($24,000 for inpatient hospital care and $8,000 for other services). The lifetime cost of medical care for a PWA is calculated to be $85,333. This is higher than many previous estimates of lifetime costs due to increased longevity and the diffusion of costly outpatient drugs. The cost of treating all people with HIV in 1991 is forecast to be $5.8 billion. Of this amount, it is estimated that $1.4 billion will be spent on people with HIV without AIDS, and the remaining $4.4 billion on PWAs. It is forecast that the cost of treating all people with HIV will increase 21% each year between 1991 and 1994, and that $10.4 billion will be spent on treating all people with HIV in 1994.

Two methods used to forecast AIDS cases--trend analysis and back calculation--are examined in this paper. I forecast AIDS cases using trend analysis with data on the number of cases reported between January 1984 and March 1990. Forecasts using back calculation methods are based on the assumption that the progression rates from HIV to AIDS slowed in 1988 due to the use of AZT and aerosol pentamidine. With both methods, reasonable models yield widely different forecasts. Analysis also is hampered by a lack of information about the basic determinants of AIDS incidence, changes in the definition of AIDS, underreporting, and uncertainty about the effect of the use of prophylactic drugs. It is not possible to establish confidence limits around forecasts that take into account these sources of biases, and it is important that those who use AIDS forecasts be aware of these uncertainties.