The 'Medicaidization' of AIDS: trends in the financing of HIV-related medical care

Although the average cost of providing lifetime medical care for a patient with AIDS ranges from $40,000 to $75,000, there is little information regarding the source of funds used for paying this expense. The present study addresses the issue of who pays the bills for this group of human immunodeficiency virus (HIV)-infected patients. Hospital discharge summaries maintained in databases by the states of California (1983 to 1987) and New York (1983 to 1988) were used to extract information regarding the employment status and payer for hospitalized AIDS patients in New York City, Los Angeles, and San Francisco. These three cities comprise approximately one-third of all AIDS cases within the United States. Over the course of the period studied, there was a conspicuous trend in movement from private insurance to Medicare, referred to as 'Medicaidization'. The incidence of AIDS has increased at a more rapid rate among blacks and hispanics, who tend to be poorer than whites. Because Medicaid eligibility is dependent on financial consideration, whites, blacks and hispanics were studied separately. While blacks and hispanics were found to have a higher probability of utilizing Medicaid, all three groups of patients with AIDS were found to show a 'Medicaidization' over time. In Los Angeles, the possibility that an individual hospitalized with AIDS is likely to be a Medicaid beneficiary is approximately three times that of a patient with another diagnosis. This results, in part, because most persons with AIDS must qualify as disabled before receiving Medicaid. In California persons with AIDS qualify as disabled persons without the usual case-by-case review required for individuals with other diagnoses. In addition, the fact that Medicaid reimbursements are considerably lower than those paid by private insurers leads some physicians to refuse services to particular groups of patients. This leads to a concomitant migration from private physicians to institutional care. (Consumer Summary produced by Reliance Medical Information, Inc.)