BOX 2
Barriers to HIV Care in 2005 Identified by the IOM’s Committee on the Public Financing and Delivery of HIV Care

Current public financing strategies for HIV care have provided care to and extended the lives of many low-income individuals. However, significant disparities remain in assuring access to the standard of care for HIV across geographic and demographic populations.

The current federal–state partnership for financing HIV care is unresponsive to the fact that HIV/AIDS is a national epidemic with consequences that spill across state borders. State Medicaid programs that provide a significant proportion of coverage for HIV care are dependent upon widely varying resources and priorities that produce an uneven and therefore ineffective approach to managing the epidemic.

Under the current patchwork of public programs that finance HIV care, many HIV-infected individuals have no access or limited access to the standard of care for HIV. Fragmentation of coverage, multiple funding sources with different eligibility requirements that cause many people to shift in and out of eligibility, and significant variations in the type of HIV services offered in each state prevent comprehensive and sustained access to quality HIV care.

Low provider reimbursement in Medicaid and managed care delivery systems has the potential to discourage experienced physicians from treating patients with HIV infection and to undermine the quality of HIV care.

SOURCE: IOM, 2005.

many policy-related barriers to access to the standard of care for HIV in the United States (IOM, 2005) (Box 2). The IOM committee faulted the public response to HIV and described a patchwork of public programs offering fragmented care and health care providers inadequately reimbursed for their services. Most of the barriers to care identified in the 2005 IOM report are still present today.

POLICIES THAT PROMOTE OR INHIBIT CLINICAL CARE SERVICES AMONG AGENCIES AT THE FEDERAL LEVEL, STATE LEVEL, OR BETWEEN FEDERAL AND STATE AGENCIES

Jennifer Kates, Kaiser Family Foundation, noted that the health care financing and delivery system in the United States has gaps in access to care that vary by state. Problems in accessing care can be acute for the general population, but they are particularly onerous for individuals with HIV/AIDS who, as a group, are more likely to be poor and disadvantaged. On



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