ever, and perhaps inevitably, they attempt to shift costs and responsibilities to one another in an effort to free up resources for other programs or priorities. Policy makers at every level are faced with developing and implementing fiscally responsible and politically viable policies that meet the needs of their constituencies.

That all of these various individuals and the organizational entities they represent would have differing goals is not always inappropriate. Each has a role to play and may be required to provide a balance to some other element of the system. However, it is important to remember that individual elements are parts of a whole. What are the goals of the whole—the publicly funded HIV/AIDS care system itself? Defining the goals of the HIV/AIDS care system is a crucial step toward improving it. There must be a system-level set of objectives that integrates the needs and interests of the various elements into a common cause, in order to provide rationality to the system.

Goals for the HIV/AIDS Care System

The Committee believes the primary goal of the publicly funded system of HIV care should be to improve the quality and duration of life for those with HIV and promote effective management of the epidemic by providing access to comprehensive care to the greatest number of individuals with HIV infection.

The Committee defined four secondary objectives of the system around the essential concepts of access, quality, efficiency, and accountability:

  • Ensure HIV-infected individuals early and continuous access to an appropriate, comprehensive set of medical and ancillary services that meet the standard of care (access).

  • Promote the delivery of high-quality services (quality).

  • Facilitate the provision of services with a minimum of administrative costs (for payers and providers) and a minimum of duplication of effort (efficiency).

  • Ensure accountability of the financing and service delivery system for meeting established standards of treatment and health outcomes for all eligible individuals (accountability).

The financial portion of this goal will be discussed in Chapter 6.

These four objectives define the goals of an integrative chronic care system that can appropriately meet the needs of both individuals with HIV/AIDS and the providers who serve them.

With these goals and objectives as a backdrop, the Committee asked the following questions: Does the financing system described in this and

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