Important note: Information in this article was accurate in 1988. The state of the art may have changed since the publication date.
The Adequacy of Hospital Reimbursement for AIDS Patients
AIDS & Public Policy Journal 3, no. 1 (Winter 1988): 1-7 John Clark and David B. McCallum
The purpose of this study is to explore the financial strain that the provision of care to AIDS patients placed on Georgetown University Hospital, a 535-bed teaching hospital in Washington, D.C., between 1982 and 1986. We sought to determine what proportion of this hospital's estimated inpatient cost for treating AIDS patients was reimbursed by various payors: commercial insurers, Blue Cross/Blue Shield, Medicaid, and self-pay/indigents. A second objective of this research was to evaluate the usefulness of Medicare's diagnosis-related groups (DRGs) in reimbursing hospitals for AIDS care. DRGs are categories, 473 in all, into which discharged hospital patients are classified on the basis of their principal diagnosis, age, presence of complications, discharge status (dead or alive), and sometimes the surgical procedure performed in the hospital. Hospitals are paid a prospective rate per DRG by Medicare. If a hospital can treat and discharge a patient for less than the DRG payment then the hospital keeps the profit. Conversely, a hospital bears the financial burden if the patient costs more to treat than the DRG payment. In theory, hospitals that are operating efficiently should break even or make a reasonable profit. Between 1 and 3 percent of AIDS patients currently have Medicare coverage, so only a small fraction of payments made to hospitals for AIDS care are Medicare DRG based. However, the use of DRGs for reimbursement may increase in the future as other third-party payors adopt prospective means of payment. Moreover, with the development of new drugs, more AIDS patients may become eligible for Medicare as greater numbers survive the current two-year Medicare eligibility waiting period required for disability classification.
880115
APPJ883101
AEGiS is made possible through unrestricted grants from Boehringer Ingelheim, Elton John AIDS Foundation, Bridgestone/Firestone Charitable Trust, the National Library of Medicine, and donations from users like you. Always watch for outdated information. This article first appeared in 1988. This material is designed to support, not replace, the relationship that exists between you and your doctor.
AEGiS presents published material, reprinted with permission and neither endorses nor opposes any material. All information contained on this website, including information relating to health conditions, products, and treatments, is for informational purposes only. It is often presented in summary or aggregate form. It is not meant to be a substitute for the advice provided by your own physician or other medical professionals. Always discuss treatment options with a doctor who specializes in treating HIV.
Important note: Information in this article was accurate in 1988. The state of the art may have changed since the publication date.
