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The Experience of a Large Prepaid Health Plan

Robert A. Hiatt, MD, PhD; Charles P. Quesenberry, Jr, PhD; Joseph V. Selby, MD, MPH; Bruce H. Fireman, MS; Anthony Knight, MBA

Arch Intern Med. 1990;150(4):833-838.

Abstract
• We studied the cost of acquired immunodeficiency syndrome (AIDS) in the Kaiser Permanente Medical Care Program (KPMCP), northern California region. We report the costs of care to the KPMCP and introduce an innovative application of survival methods to cost analysis. From the beginning of the AIDS epidemic in 1981 to the end of June 1987, 866 cases of AIDS were recorded among members of the KPMCP. Estimates of the costs of care of these patients were derived from comprehensive chart reviews of a random sample of 71 patients whose conditions were diagnosed from January 1984 through June 1987. Total mean lifetime costs per patient were $32 816 (median, $28 677), whereas the mean hospital per diem cost was $20 446 per patient. As more care was shifted to outpatient services over time, overall costs dropped, despite marked increases in the cost of outpatient medications such as zidovudine. The overall estimate of cost compared closely with other estimates of the cost of care in San Francisco, Calif, and it is lower than estimates from elsewhere in the United States, probably because of the low proportion of cases associated with intravenous drug use and the well-developed social support networks available to patients with AIDS in the San Francisco Bay Area.

(Arch Intern Med. 1990;150:833-838)

Author Affiliations
From the Division of Research (Drs Hiatt, Quesenberry, and Selby, and Mr Fireman) and the Department of Financial Analysis (Mr Knight), Kaiser Permanente Medical Care Program, Northern California Region, Oakland.

Footnotes
Accepted for publication December 5,1989.

Reprint requests to Division of Research, Kaiser Permanente Medical Care Program, 3451 Piedmont Ave, Oakland, CA 94611 (Dr Hiatt).

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