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Patterns of Utilization and Charges in a Public Health Care System

Cornelis A. Rietmeijer, MD, MSPH; Arthur J. Davidson, MD, MSPH; Cliff T. Foster; David L. Cohn, MD

Arch Intern Med. 1993;153(2):219-225.

Abstract
Background
The increasing impact of human immunodeficiency virus (HIV) infection on the health care delivery system requires surveillance of current patterns of HIV-related health care utilization to adequately plan for future needs. Most studies to date have concentrated on inpatient care for patients with the acquired immunodeficiency syndrome (AIDS). Outpatient utilization has been less well studied and there are few data regarding HIV-infected patients without a diagnosis of AIDS.

Methods
Denver Health and Hospitals is a public system delivering comprehensive health care to mostly indigent residents of the city and county of Denver. Patients with HIV infection in this system were identified through multiple surveillance sources, and billing system records for these patients were analyzed.

Results
During 1990, 812 patients with HIV infection of 13 years or more were accessed in the Denver Health and Hospitals. During that year, the total HIV-related health care charges were $7 858 690, of which 57% were for inpatient care and 43% for ambulatory care. Patients with AIDS (34% of patients) accounted for 62% of all charges, and patients with HIV infection but without a diagnosis of AIDS (66% of patients) for 38% of charges. Compared with national predictions, patients with AIDS in our system had lower inpatient and higher outpatient utilization.

Conclusions
These results are consistent with a shift from inpatient to outpatient health care services in patients with AIDS. A significant proportion of HIV-related health care costs are incurred by patients who have not yet developed AIDS.

(Arch Intern Med. 1993;153:219-225)

Author Affiliations
From the Denver Disease Control Service (Drs Rietmeijer, Davidson, and Cohn) and Biostatistics Section (Mr Foster), Denver Department of Health and Hospitals, the Departments of Preventive Medicine (Drs Rietmeijer and Davidson) and Medicine (Dr Cohn), University of Colorado Health Sciences Center.

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