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Previous Volume 339:1897-1904 December 24, 1998 Number 26 Next

	Full Text PDF Editorial by Steinbrook, R. Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background and Methods In order to elucidate the medical care of patients with human immunodeficiency virus (HIV) infection in the United States, we randomly sampled HIV-infected adults receiving medical care in the contiguous United States at a facility other than a military, prison, or emergency department facility during the first two months of 1996. We interviewed 76 percent of 4042 patients selected from among the patients receiving care from 145 providers in 28 metropolitan areas and 51 providers in 25 rural areas.

Results During the first two months of 1996, an estimated 231,400 HIV-infected adults (95 percent confidence interval, 162,800 to 300,000) received care. Fifty-nine percent had the acquired immunodeficiency syndrome according to the case definition of the Centers for Disease Control and Prevention, and 91 percent had CD4+ cell counts of less than 500 per cubic millimeter. Eleven percent were 50 years of age or older, 23 percent were women, 33 percent were black, and 49 percent were men who had had sex with men. Forty-six percent had incomes of less than $10,000 per year, 68 percent had public health insurance or no insurance, and 30 percent received care at teaching institutions. The estimated annual direct expenditures for the care of the patients seen during the first two months of 1996 were $5.1 billion; the expenditures for the estimated 335,000 HIV-infected adults seen at least as often as every six months were $6.7 billion, which is about $20,000 per patient per year.

Conclusions In this national survey we found that most HIV-infected adults who were receiving medical care had advanced disease. The patient population was disproportionately male, black, and poor. Many Americans with diagnosed or undiagnosed HIV infection are not receiving medical care at least as often as every six months. The total cost of medical care for HIV-infected Americans accounts for less than 1 percent of all direct personal health expenditures in the United States.

Source Information

From RAND Health, Santa Monica, Calif. (S.A.B., S.H.B., N.D., A.A.L., J.W.S., S.C.M., M.F.S.); the Veterans Affairs San Diego Healthcare System, San Diego, Calif., and the University of California at San Diego, La Jolla (S.A.B.); the University of California at Los Angeles (A.A.L., M.F.S.); the National Opinion Research Center, Chicago (M.R.F., C.-A.E.); Baruch College, City University of New York, New York (M.R.F.); Project Hope, Bethesda, Md. (M.L.B.); and the Agency for Health Care Policy and Research, Rockville, Md. (D.L.). Other authors were Ronald M. Andersen, Ph.D., William E. Cunningham, M.D., M.P.H., Marvin Marcus, D.D.S., M.P.H., and Neil S. Wenger, M.D., University of California at Los Angeles; Leslie A. Athey, M.S., and Stephen M. Smith, M.A., National Opinion Research Center, Chicago; Eric G. Bing, M.D., Drew University, Los Angeles; Julie A. Brown, B.A., M. Audrey Burnham, Ph.D., Dana P. Goldman, Ph.D., David E. Kanouse, Ph.D., Joan W. Keesey, B.A., Daniel F. McCaffrey, Ph.D., Judith F. Perlman, M.A., and Mark A. Schuster, M.D., Ph.D., RAND Health, Santa Monica, Calif.; Paul D. Cleary, Ph.D., Harvard Medical School, Boston; John A. Fleishman, Ph.D., Agency for Health Care Policy and Research, Rockville, Md.; Ron D. Hays, Ph.D., RAND Health, Santa Monica, Calif., and the University of California at Los Angeles; J. Allan McCutchan, M.D., and Douglas Richman, M.D., University of California at San Diego, La Jolla.

Address reprint requests to Dr. Bozzette or Dr. Shapiro, HCSUS Office, RAND, 1700 Main St., Santa Monica, CA 90407-2138.

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