Equitable Financing of AIDS and Other HIV-related Health Care Summary of a Meeting (1988) / Chapter Skim
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Meeting Summary
Meeting Summary
Pages 1-12
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From page 1... ...
Should such policies include special treatment of HIV patients on the grounds of special needs, or does special treatment constitute unfair discrimination against other equally deserving groups? On February 10 and 11, 1988, at the request of the Health Care Financing Administration, a meeting was convened by the Institute of Medicine.
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From page 2... ...
However, the meeting's sponsors consider it worthwhile to issue a summary of the "sense of the meeting," committing to writing the areas of agreement and disagreement that emerged in the discussion. HIV Financing in Perspective Meeting participants agreed on the need to place the financing of HIV-related care in the context of total expenditures on personal health care.
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From page 3... ...
There was discussion of efforts by entities such as the National Center for Health Services Research, the Health Care Financing Administration, the Centers for Disease Control, philanthropic foundations, and private insurance organizations to develop more information. Private insurance representatives emphasized the difficulties in using claims data to ascertain cost of care, because they are collected for payment purposes, not for epidemiologic or cost-of-disease studies.
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From page 4... ...
However, gaps in the system leave an estimated 37 million Americans with no public or private insurance, and millions more with inadequate coverage for a serious illness such as AIDS. Moreover, there is concern that insurers will respond to the AIDS epidemic by looking for ways to reduce their exposure to risk: for example, by requiring blood tests of prospective subscribers and rejecting those who are seropositive, or by changing marketing strategies or withdrawing altogether from markets in high incidence areas, or by restructuring benefit packages to exclude or limit services for AIDS patients.
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From page 5... ...
If anything, AIDS may be reinforcing a trend toward use of individualized case management for the seriously ill, with modification of standard coverage rules possible when it is in the interest of both patient and insurer (for example, to pay for home health care as a substitute for inpatient hospital care)
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From page 6... ...
They contend that private insurance firms are part of a system whose goal is fulfillment of a societal obligation to guarantee Americans access to adequate health care, whatever their financial resources and whatever role their own behavior played in their illness. Screening for AIDS -- or other health risks -- undermines this system, the critics say.
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From page 7... ...
In many states Medicaid coverage of home and community-based care, supportive social services, counseling, and personal service care is limited, making it difficult to finance appropriate care for AIDS patients. However, states can apply for —7—
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From page 8... ...
The impact on the Medicaid program in the states of highest incidence has been severe, creating dilemmas of resource allocation between the needs of those with HIV infection and the needs of the traditional Medicaid clients. Some discussants questioned whether Medicaid was an appropriate vehicle for financing HIV-related care, given the uneven incidence of the disease and their belief that many —8—
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From page 9... ...
Meeting participants discussed the fact that Medicare is a national program and would therefore have certain advantages over Medicaid in spreading the burden of the disease on a broader basis and achieving similar treatment of AIDS patients wherever they are. On the other hand, eliminating the waiting period only for AIDS patients would be expensive and would raise serious questions of fairness to those suffering from other disabling conditions; the costs of eliminating the waiting period for all the permanently disabled would be very high indeed.
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From page 10... ...
There was agreement that radical restructuring of the health care financing system as a whole, or even of individual parts of it such as Medicaid and Medicare, is unlikely to be feasible in the immediate future, therefore, it is necessary to look for methods of adapting the existing system in incremental ways to meet the AIDS challenge. There was agreement that the financing of care for HIV-related -10
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From page 11... ...
For this group, the challenge is to explore possibilities for financing needed care without straining existing public programs too far. Possibilities discussed included increased use of Medicaid waivers, other options such as hospice care and case management programs, elimination of the Medicare waiting period, and special "impact grants" to state Medicaid programs or directly to state and local governments in areas of high incidence.
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From page 12... ...
There was agreement that, although there is a special stigma attached to HIV-related illness, the physical suffering and financial burdens are not unique; they are experienced by many of those who suffer from other serious health conditions. Therefore, fairness across diseases is an important consideration in the development of policies for the financing of HIV-related care.
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