AIDS Cost Analysis and Social Policy

Fox DM , AIDS and the American health polity: The history and prospects of a crisis of authority, Milbank Quarterly 1986, 64: 7–33.

Two examples of early descriptions of the cost are: AIDS patients cost $16,652 …, Blue Sheet, November 6, 1987: 9; AIDS costs. Wall Street Journal, October 18, 1985.

Cooper BS Rice DP , The economic cost of illness revisited, Social Security Bulletin, Washington: U.S. Government Printing Office, 1976. DHEW Pub. No. (SSA) 76-11703, Office of Research and Statistics, Social Security Administration.

Weisbrod BA , The economics of public health, Philadelphia: University of Pennsylvania Press, 1961.

Hartunian NS Smart CN Thompson MS , The incidence and economic costs of major health impairments, Lexington: Heath, 1981.

Hodgson TA Meiners MR , Cost-of-illness methodology: A guide to current practices and procedures, Milbank Memorial Fund Quarterly 1982, 60: 433.

Id.: 429–62; Scitovsky AA , Estimating the direct costs of illness, Milbank Memorial Fund Quarterly 1982, 60: 463–91. In a paper published in Science as we went to press, two economists asserted that “charge data are more reliable, more widely available, and, in practice, probably measure ‘true economic cost’ more accurately than cost data.” Neither they nor, presumably, the reviewers for Science seem to know that hospitals traditionally construct charges to be what private insurers will bear and consciously use them to subsidize lower payments (“costs”) by more restrictive payers. The paper provides, however, a useful update of the results of previous cost studies by converting their findings to 1986 dollars. Discounting the results of the San Francisco study on the grounds that they are “likely to be substantially below the national average,” the authors conclude that the lifetime cost of care will not exceed $80,000. Bloom DE Carliner G , The economic impact of AIDS in the United States, Science 1988, 239: 604–9.

Hardy AM , The economic impact of the first 10,000 cases of acquired immunodeficiency syndrome in the United States, Journal of the American Medical Association 1986, 225: 209–11.

Personal communication from HCFA staff to Fox.

Scitovsky AA , Medical care costs of patients with AIDS in San Francisco, Journal of the American Medical Association 1986, 256: 3103–6.

Fox DM , The cost of AIDS from conjecture to research, AIDS & Public Policy Journal 1987, 2: 25–27.

Personal communication from HCFA staff to Fox.

Berger R , Cost analysis of AIDS cases in Maryland, Maryland Medical Journal 1985, 24: 1173–75.

Seage GR , Medical care costs of AIDS in Massachusetts, Journal of the American Medical Association 1986, 256: 3107–9.

Kizer KW , A quantitative analysis of AIDS in California, unpublished report, 1986. The author estimates the average cost of AIDS patients to Medi-Cal to be $59,000, substantially below estimated hospital charges of $91,000.

Fox participated in a site visit to San Francisco organized by the New York State Department of Health prior to the planning of the treatment centers program in New York.

The contribution of community-based organizations is described in Arno PS, The non-profit sector's response to the AIDS epidemic: Community-based services in San Francisco, American Journal of Public Health 1986, 76: 1325–30.

Marwick Peat Mitchell , Study of routine costs of treating hospitalized AIDS patients, New York: Greater New York Hospital Association, 1986.

Letter to Thomas from Philip Mossman, State of New York Department of Health, July 1987.

Thomas EH Fox DM , The cost of treating persons with AIDS in four hospitals in metropolitan New York in 1985, New York: Health Service Improvement Fund, sponsored by Empire State Blue Cross and Blue Shield, 1987 (processed).

Scitovsky AA Rice DP , Estimates of the direct and indirect costs of acquired immunodeficiency syndrome in the United States, 1985, 1986 and 1990, Public Health Reports 1987, 102: 5–17.

Three recent publications have made this point: Sisk JE , The costs of AIDS: A review of the estimates, Health Affairs 1987, 6: 5–21; Arno PS , The economic impact of AIDS, Journal of the American Medical Association 1987, 258: 1376–77; Green J , Projecting the impact of AIDS on hospitals, Health Affairs 1987, 6: 19–31. Iglehart has described the burden that incremental decisions about AIDS have placed on DHHS in Iglehart JK , Financing the struggle against AIDS, New England Journal of Medicine 1987, 317: 180–84.

Government-funded hospice facilities for people with AIDS are recommended by intergovernmental task force, Blue Sheet, September 16, 1987.

Pascal A , The costs of treating AIDS under Medicaid: 1986–1991, Santa Monica: RAND, 1987.

Andrulis DP , The provision and financing of medical care for AIDS patients in U.S. public and private teaching hospitals, Journal of the American Medical Association 1987, 258: 1343–46.

The protocols are being developed by the Palo Alto Medical Foundation under the direction of Anne Scitovsky, in collaboration with researchers at the University of California-San Francisco, SRI, and New York University.

Graves and Moien also suggest a shift from private insurance to Medicaid. Finding that 55 percent of AIDS discharges in their sample indicated private insurance as their expected source of payment and 21 percent Medicaid, they conclude: “These figures were significantly different from the distribution of all patients under 65 years of age.” A higher proportion (63 percent) of the total discharges under 65 years of age indicated private insurance as the principal expected source of payment, and a lower proportion listed Medicaid (13 percent). Graves EJ Moien M , Hospitalization for AIDS, United States, 1984–85, American Journal of Public Health 1987, 77: 729–30. Pascal cites evidence that the proportion of persons with AIDS on Medicaid is increasing (supra note 24, at 11).

The inpatient cost projection of $7.741 billion is calculated by deducting outpatient costs on a pro rata basis from the projected total. Inpatient care comprises 90.6 percent of the annual cost per case used in this projection ($3,000, out of total costs of $31,900 in 1984 dollars).

National AIDS registry, modeled on cancer registry, proposed by Yale professor to AIDS commission, Blue Sheet, January 20, 1988, at 5.

American Council of Life Insurers (ACLI) and Health Insurance Association of America (HIAA), Insurance company claims and practices relating to AIDS, Health Insurance Association of America Research and Statistical Bulletin 1986, 4–86.

Anderman S . unpublished data reported in Scitovsky (see below).

Andrulis DP , The provision and financing of medical care for AIDS patients in the U.S. public and private teaching hospitals, Journal of the American Medical Association 1987, 258: 258–46.

Arno PS , The non-profit sector's response to the AIDS epidemic: Community-based services in San Francisco, American Journal of Public Health 1986, 76: 76–30.

Belmont MF , St. Luke's-Roosevelt Hospital Center study: Resource utilization by AIDS patients in the acute care hospital, New York: Health Service Improvement Fund, sponsored by Empire State Blue Cross and Blue Shield, 1985 (processed).

Berger R , Cost analysis of AIDS cases in Maryland, Maryland Medical Journal 1985, 24: 24–75.

Graves EJ Moien M , Hospitalization for AIDS, United States, 1984–85, American Journal of Public Health 1987, 77: 77–30.

Hardy AM , The economic impact of the first 10,000 cases of acquired immunodeficiency syndrome in the United States, Journal of the American Medical Association 1986, 225: 225–11.

Health Care Financing Administration, U.S. Department of Health and Human Services, Office of the Actuary, Revised estimates of Medicaid impact of AIDS, 1986, cited in Sisk (see below).

Hegerty J , findings presented at the Third International Conference on AIDS, Washington D.C., June 1–5; reported in Technology Reimbursement Reports, June 12, 1987.

Hodgson TA Kopstein AN , Health care expenditures for major diseases in 1980, Health Care Financing Review 1984,5: 5–12.

Kizer KW , A quantitative analysis of AIDS in California, unpublished report, 1986.

Long SH , Medical expenditures of terminal cancer patients during the last year of life, Inquiry 1984, 21:315–27, as updated in Seage , 1986 (see below).

Lubitz J Prihoda R , The use and costs of Medicare services in the last 2 years of life, Health Care Financing Review 1984,5: 5–31.

Mossman P , State of New York Department of Health, letter to Thomas, July 1987.

Pascal A , The costs of treating AIDS under Medicaid: 1986–1991, Santa Monica: RAND, 1987.

Mitchell Peat Marwick (PMM), Study of routine costs of treating hospitalized AIDS patients, New York: Greater New York Hospital Association (GNYHA), 1986.

Rice DP Hodgson TA , and Kopstein AN , The economic costs of illness: A replication and update, Health Care Financing Review 1985, 7: 7–80.

Scitovsky AA , Medical care costs of patients with AIDS in San Francisco, Journal of the American Medical Association 1986, 256: 256–6; augmented by a letter to Fox.

Scitovsky AA Rice DP , Estimates of the direct and indirect cost of acquired immunodeficiency syndrome in the United States, 1985, 1986, and 1990, Public Health Reports 1987, 102: 102–17.

Seage GR , Medical care costs of AIDS in Massachusetts, Journal of the American Medical Association 1986, 256: 256–9.

Seage GR , Cost of medical care for AIDS in Massachusetts: Trends over a two-year period, Abstracts volume, Third International Conference on AIDS, Washington, D.C., 1987: 1–5; cited in Sisk (see below).

Sisk JE , The costs of AIDS: A review of the estimates, Health Affairs 1987, 6: 6–21.

Thomas EH Fox DM , The cost of treating persons with AIDS in four hospitals in metropolitan New York in 1985, New York: Health Service Improvement Fund, sponsored by Empire State Blue Cross and Blue Shield, 1987 (processed).

Thomas EH Fox DM . (1987a), The cost of AZT, AIDS and Public Policy Journal 1987, 2: 2–21.