Objectives: Assess the impact of ancillary services' utilization on access, adequacy and utilization of primary care, utilization of inpatient and emergency room services, costs and health status of HIV/AIDS patients.
Methods: Using primary data from a 1997-98 survey of Medicaid-eligible adult HIV/AIDS patients in eastern North Carolina linked to Medicaid claims, multivariate logit analysis estimates effects of 10 ancillary services on a)access to primary care, b)adequacy of primary care, c)utilization of inpatient services, d)average monthly Medicaid payments, e)CD-4 counts; f)self-rated health status, g)activities of daily living; or h)depression.
Results: Case management tends to be positively related to primary care access for Medicaid-eligible HIV/AIDS patients, but other ancillary services such as emergency food, housing, legal, and transportation occasionally have a negative relationship with access, adequacy or utilization of primary care. We are further testing whether ancillary services affect inpatient utilization, Medicaid costs or health status. We hypothesize that those with such self-reported barriers to obtaining adequate ancillary services are less likely to receive continuous primary care (at least once every six months), are more likely to experience avoidable inpatient stays, will therefore impose higher average costs on Medicaid and have worse health status. This latter analysis will be completed in spring 2000.
Conclusions: Nearly one-fourth of Ryan White CARE Act funding is allocated for various ancillary services--including transportation and child care--offered to remove barriers for patients with HIV/AIDS. Our findings are expected to inform federal policy regarding whether funding of such ancillary services should continue and at what level.
Learning Objectives: At the conclusion of the session, the participant in this session will be able to: (1) Define barriers to ancillary services in rural areas; (2) Assess the relationship between utilization of ancillary and primary care services; and (3) Outline research hypotheses to explain the influence of such barriers on cost of care and health outcomes
Keywords: Ryan White, Case Management
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.