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Trends in the Financing of HIV-Related Medical Care

Jesse Green, PhD; Peter S. Arno, PhD

JAMA. 1990;264(10):1261-1266.

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.

(JAMA. 1990;264:1261-1266)

Author Affiliations
From the Department of Health Policy Research, New York University Medical Center, School of Medicine, New York City (Dr Green), and Department of Epidemiology and Social Medicine, Montefiore Medical Center, Einstein College of Medicine (Dr Arno), Bronx, NY.

Footnotes
Presented in part at the Sixth International Conference on AIDS, San Francisco, Calif, June 22, 1990.

Reprint requests to Department of Health Policy Research, New York University Medical Center, 550 First Ave (IRM), New York, NY 10016 (Dr Green).

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