Marc L. Berk

The Care of HIV-Infected Adults in the United States

BACKGROUND AND METHODS In order to elucidate the medical care of patients with human immunodeficiency virus (HIV) infection in the United States, we randomly sampled HIV-infected adults receiving medical care in the contiguous United States at a facility other than military, prison, or emergency department facility during the first two months of 1996. We interviewed 76 percent of 4042 patients selected from among the patients receiving care from 145 providers in 28 metropolitan areas and 51 providers in 25 rural areas. RESULTS During the first two months of 1996, an estimated 231,400 HIV-infected adults (95 percent confidence interval, 162,800 to 300,000) received care. Fifty-nine percent had the acquired immunodeficiency syndrome according to the case definition of the Centers for Disease Control and Prevention, and 91 percent had CD4+ cell counts of less than 500 per cubic millimeter. Eleven percent were 50 years of age or older, 23 percent were women, 33 percent were black, and 49 percent were men who had had sex with men. Forty-six percent had incomes of less than

The importance of distinguishing Hispanic subpopulations in the use of medical care.

10,000 per year, 68 percent had public health insurance or no insurance, and 30 percent received care at teaching institutions. The estimated annual direct expenditures for the care of the patients seen during the first two months of 1996 were

The Care of HIV-infected Adults in Rural Areas of the United States

5.1 billion; the expenditures for the estimated 335,000 HIV-infected adults seen at least as often as every six months were

Short report: Migration among persons living with HIV

6.7 billion, which is about

Interviewer characteristics and performance on a complex health survey

20,000 per patient per year. CONCLUSIONS In this national survey we found that most HIV-infected adults who were receiving medical care had advanced disease. The patient population was disproportionately male, black, and poor. Many Americans with diagnosed or undiagnosed HIV infection are not receiving medical care at least as often as every six months. The total cost of medical care for HIV-infected Americans accounts for less than 1 percent of all direct personal health expenditures in the United States.

Connecting The Ivory Tower To Main Street: Setting Research Priorities For Real-World Impact

Rather than analyzing Hispanics as a homogeneous population, this paper uses the 1977 National Medical Care Expenditure Survey in order to make separate national estimates for Cubans, Puerto Ricans, and Mexicans. Utilization of various health services by these three groups is discussed, as well as their insurance coverage, mean annual expenses by source of payment, and health status indicators. The analysis has a descriptive as well as multivariate component and focuses specifically on the use of physician and hospital services and prescribed medicines. It is found that Puerto Ricans are almost twice as likely as Mexicans, and over four times as likely as Cubans, to be covered by Medicaid; Cubans, on the other hand, are most often privately insured. Of the three groups, Puerto Ricans have the highest annual expenses and are most likely to have at least one physician visit. The number of visits for those with a visit, however, is identical across the groups. The paper discusses the policy implications of these findings, as well as the methodologic implications of classifying various Hispanic subgroups into one all-encompassing category.

The health care of poor persons living in wealthy areas

Objective: This study describes the population of HIV‐infected adults receiving care in rural areas of the United States and compares HIV care received in rural and urban areas. Methods: Interviews were conducted with a nationally representative sample of 367 HIV‐infected adults receiving health care in rural areas and 2806 HIV‐infected adults receiving health care in urban areas of the contiguous United States. Results: We estimate that 4800 HIV‐infected persons received medical care in rural areas during the first half of 1996. Patients in rural HIV care were more likely than patients in urban HIV care to receive care from providers seeing few (<10) HIV‐infected patients (38% vs. 3%; p < .001). Rural care patients were less likely than urban care patients to have taken highly active antiretroviral agents (57% vs. 73%; p < .001) or Pneumocystis carinii pneumonia prophylactic medication when indicated (60% vs. 75%; p = .006). Conclusions: Few American adults received HIV care in rural areas of the United States. Our findings suggest ongoing disparities between urban and rural areas in access to high‐quality HIV care.

Health insurance coverage of the working poor

Data from the first national probability sample of persons with HIV, the HIV Cost of Services and Utilization Survey (HCSUS), are used to examine migration patterns among persons with HIV/AIDS in the USA. Persons with serious illness may choose to relocate to receive better care or support. This migration has implications for the distribution of resources. This study describes the frequency and reasons that persons with HIV move to different communities. An analytic file of 3014 respondents was obtained from the first national probability sample of persons with HIV/AIDS, the HCSUS. A migration section of the baseline questionnaire questioned respondents on their residential history. Persons were defined as movers if they moved across state lines or to a non-contiguous county after knowing they were HIV positive but before the HCSUS baseline interview. Forty percent of movers said that their HIV status was a very important factor in their decision to move. Although earlier studies of limited generalizability found movement among the HIV population from urban to rural counties, this study found only eight percent of HIV migration was from urban to rural counties, just slightly more than the migration from rural to urban counties. In addition, the vast majority of people who were moving were not moving to return home. Major factors in the decision to move included being near caregivers and being in a community with shared needs and interests. Significant numbers of persons also moved to obtain care from a physician knowledgeable in HIV treatment or to get away from discrimination. Financial assistance and the availability of Medicaid also played a prominent role in many decisions to move. Persons with HIV/AIDS are more likely to move than non-infected persons in the general population. Moreover, they are almost twice as likely to be moving out-of-state. Persons with HIV who move are similar to persons with HIV who do not move on most demographic characteristics including age, region of the country, and income.

Methodological Issues in Health Surveys An Evaluation of Procedures Used in the National Medical Care Expenditure Survey

Abstract This paper examines interviewer characteristics and their effect on interviewer performance during a complex health survey. The study is based on an examination of 206 interviewers employed on the National Medical Care Expenditure Survey. Two measures of interviewer performance are evaluated; item nonresponse rates and validity as measured from a verification survey of providers. Neither the experience nor the education of the interviewer was associated with any measures of interviewer performance. Although there is wide variance in interviewer performance, ability to obtain complete expenditure data is not clearly associated with those interviewer characteristics that can readily be measured.

Young Adult Insurance Coverage And Out-Of-Pocket Spending: Long-Term Patterns.

Health care decisionmakers face increasing pressure to use health care resources more efficiently, but the information they need to assess policy options often is unavailable or not disseminated in a useful form. Findings from stakeholder meetings and a survey of private-sector health care decisionmakers in California begin to identify high-priority issues, the perceived adequacy of current information, and preferred formats and other desired attributes of research. This is a first step in establishing a systematic approach to linking the information priorities of private-sector decisionmakers with those who fund and conduct research.