The 'Medicaidization' of AIDS. Trends in the financing of HIV-related medical care

Abstract

Among patients with the acquired immunodeficiency syndrome (AIDS) who were hospitalized in New York City, San Francisco, Calif, and Los Angeles, Calif, from 1983 through 1988, we observed a marked shift in the payer distribution toward Medicaid and away from private insurance. This trend, which we refer to as the "Medicaidization" of AIDS, occurred among whites as well as blacks and Hispanics and increased the burden on public hospitals and emergency rooms. "Medicaidization" jeopardizes access to office-based primary care because of very low reimbursement rates that are paid to physicians by Medicaid relative to private insurance. Policies designed to prevent the loss of employment-based private insurance would slow or reverse the trend to public financing. Increasing Medicaid reimbursement will improve access to care.

KIE: Hospitalization rates for AIDS and HIV-related conditions in New York City, Los Angeles, and San Francisco from 1983 through 1988 were studied to determine trends in the funding of AIDS-related care. The authors noted that increasingly care has been financed through Medicaid rather than through private health insurers, and that this trend has occurred among white, black, and Hispanic patients. Study data also confirmed that the "Medicaidization" of AIDS affected access to care. Patients whose treatment was financed by Medicaid were more likely to enter public rather than private hospitals, and to be admitted via an emergency room rather than by a private physician. Green and Arno are concerned that "Medicaidization," which jeopardizes access to office-based primary care because of low physician reimbursement rates, will deny new life-prolonging therapies to many AIDS patients. They propose policies that would improve access to care by strengthening AIDS financing.