Concentration of AIDS Related Impatient Care. Abstract, Executive Summary, andFinal Report. (Includes Executive Summary)

摘要

The principal challenge of the AIDs epidemic has been planning and coordinatingcare. Discussions about service delivery have prominently included debate whether AIDS care should be concentrated in a few regional centers or spread across many hospitals. Analysis of hospitalization patterns in 27 MSAs accounting for half the nation's AIDS cases between 1983 and 1992, showed uneven distributions of AIDS care. In 15 of 27 MSAs the majority of AIDS care was concentrated in 2 hospitals. GINI indices showing the degree of concentration ranged from .78 in Buffalo to .23 in Orlando. Teaching hospitals and public hospitals were associated with disproportionately high volumes of AIDS-related care. As resources for inpatient care become scarcer due to reductions in Medicaid coverage, managed care contracting, and reductions in subsidies for medical education, public and teaching hospitals will experience serious financial problems. The disproportionate concentrations of AIDS-related care in these institutions will magnify such effects because of the losses ($136 per day) associated with such care.