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AIDS Cost Analysis and Social Policy

Published online by Cambridge University Press:  28 April 2021

Daniel M. Fox  and
Emily H. Thomas
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Extract

Debates about how much it costs to treat persons with AIDS and how the burden of these costs is and ought to be distributed raise fundamental questions about social policy in the United States. The most important questions concern entitlement: Who has what obligations to provide what services to whom, under what conditions and at whose expense?

As a result of our political history, we were unprepared for the challenge of AIDS to social policy in the 1980s. We had, over a half-century, linked entitlement to medical care to age, disability, employment, and, for people with end-stage renal disease, to diagnosis. Our policies proved inadequate to pay for medical care for persons who died at considerably younger ages than normal, who were disabled for a brief period that was still long enough to end their employability, and whose condition progressed with unusual rapidity from diagnosis to death. By early 1988, it was clear that we would, as a society, assume the substantial costs of caring for persons with AIDS. Who would pay, and how equitably we would provide care, remained in debate.

Type
AIDS: Financing
Information
Law, Medicine and Healthcare , Volume 15 , Issue 4 , Winter 1987 , pp. 186 - 211
Copyright
Copyright © American Society of Law, Medicine and Ethics 1987

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References

The research reported here from the New York metropolitan area was conducted as part of a research program awarded to the authors by Health Research Inc. under a grant from the Health Services Improvement Fund sponsored by Empire State Blue Cross and Blue Shield. Needless to say, the views we express are entirely our own. We are grateful for critical comments on this paper by Mary Cline, Anne Scitovsky, and three anonymous reviewers.Google Scholar
Fox, DM, AIDS and the American health polity: The history and prospects of a crisis of authority, Milbank Quarterly 1986, 64: 7–33.Google ScholarPubMed
Two examples of early descriptions of the cost are: AIDS patients cost $16,652 …, Blue Sheet, November 6, 1987: 9; AIDS costs. Wall Street Journal, October 18, 1985.Google Scholar
Cooper, BS, Rice, DP, The economic cost of illness revisited, Social Security Bulletin, Washington: U.S. Government Printing Office, 1976. DHEW Pub. No. (SSA) 76-11703, Office of Research and Statistics, Social Security Administration.Google Scholar
Weisbrod, BA, The economics of public health, Philadelphia: University of Pennsylvania Press, 1961.Google Scholar
Hartunian, NS, Smart, CN, Thompson, MS, The incidence and economic costs of major health impairments, Lexington: Heath, 1981.Google Scholar
Hodgson, TA, Meiners, MR, Cost-of-illness methodology: A guide to current practices and procedures, Milbank Memorial Fund Quarterly 1982, 60: 433.Google ScholarPubMed
Id.: 429–62; Scitovsky, AA, Estimating the direct costs of illness, Milbank Memorial Fund Quarterly 1982, 60: 463–91. In a paper published in Science as we went to press, two economists asserted that “charge data are more reliable, more widely available, and, in practice, probably measure ‘true economic cost’ more accurately than cost data.” Neither they nor, presumably, the reviewers for Science seem to know that hospitals traditionally construct charges to be what private insurers will bear and consciously use them to subsidize lower payments (“costs”) by more restrictive payers. The paper provides, however, a useful update of the results of previous cost studies by converting their findings to 1986 dollars. Discounting the results of the San Francisco study on the grounds that they are “likely to be substantially below the national average,” the authors conclude that the lifetime cost of care will not exceed $80,000. Bloom, DE, Carliner, G, The economic impact of AIDS in the United States, Science 1988, 239: 604-9.Google ScholarPubMed
Hardy, AM et al., The economic impact of the first 10,000 cases of acquired immunodeficiency syndrome in the United States, Journal of the American Medical Association 1986, 225: 209–11.Google Scholar
Personal communication from HCFA staff to Fox.Google Scholar
Scitovsky, AA et al., Medical care costs of patients with AIDS in San Francisco, Journal of the American Medical Association 1986, 256: 3103–6.Google ScholarPubMed
Fox, DM, The cost of AIDS from conjecture to research, AIDS & Public Policy Journal 1987, 2: 25–27.Google Scholar
Personal communication from HCFA staff to Fox.Google Scholar
Berger, R, Cost analysis of AIDS cases in Maryland, Maryland Medical Journal 1985, 24: 1173–75.Google Scholar
Seage, GR et al., Medical care costs of AIDS in Massachusetts, Journal of the American Medical Association 1986, 256: 3107–9.Google ScholarPubMed
Kizer, KW et al., A quantitative analysis of AIDS in California, unpublished report, 1986. The author estimates the average cost of AIDS patients to Medi-Cal to be $59,000, substantially below estimated hospital charges of $91,000.Google Scholar
Fox participated in a site visit to San Francisco organized by the New York State Department of Health prior to the planning of the treatment centers program in New York.Google Scholar
The contribution of community-based organizations is described in Arno, PS, The non-profit sector's response to the AIDS epidemic: Community-based services in San Francisco, American Journal of Public Health 1986, 76: 1325–30.CrossRefGoogle ScholarPubMed
Marwick, Peat Mitchell, Study of routine costs of treating hospitalized AIDS patients, New York: Greater New York Hospital Association, 1986.Google Scholar
Letter to Thomas from Philip Mossman, State of New York Department of Health, July 1987.Google Scholar
Thomas, EH, Fox, DM, The cost of treating persons with AIDS in four hospitals in metropolitan New York in 1985, New York: Health Service Improvement Fund, sponsored by Empire State Blue Cross and Blue Shield, 1987 (processed).Google Scholar
Scitovsky, AA, Rice, DP, Estimates of the direct and indirect costs of acquired immunodeficiency syndrome in the United States, 1985, 1986 and 1990, Public Health Reports 1987, 102: 5–17.Google Scholar
Three recent publications have made this point: Sisk, JE, The costs of AIDS: A review of the estimates, Health Affairs 1987, 6: 5–21; Arno, PS, The economic impact of AIDS, Journal of the American Medical Association 1987, 258: 1376-77; Green, J et al., Projecting the impact of AIDS on hospitals, Health Affairs 1987, 6: 19-31. Iglehart has described the burden that incremental decisions about AIDS have placed on DHHS in Iglehart, JK, Financing the struggle against AIDS, New England Journal of Medicine 1987, 317: 180–84.Google ScholarPubMed
Government-funded hospice facilities for people with AIDS are recommended by intergovernmental task force, Blue Sheet, September 16, 1987.Google Scholar
Pascal, A, The costs of treating AIDS under Medicaid: 1986–1991, Santa Monica: RAND, 1987.Google Scholar
Andrulis, DP et al., The provision and financing of medical care for AIDS patients in U.S. public and private teaching hospitals, Journal of the American Medical Association 1987, 258: 1343–46.Google ScholarPubMed
The protocols are being developed by the Palo Alto Medical Foundation under the direction of Anne Scitovsky, in collaboration with researchers at the University of California-San Francisco, SRI, and New York University.Google Scholar
National AIDS registry, modeled on cancer registry, proposed by Yale professor to AIDS commission, Blue Sheet, January 20, 1988, at 5.Google Scholar