U.S. hospital care for HIV-infected persons and the role of public and private teaching hospitals: 1988-1991

Hospitals are a major provider of resources for individuals with HIV- related conditions. With the changing nature of HIV, tracking the dependence on and impact of related care delivered in these institutions is critical to monitoring overall resource need. This report documents HIV inpatient care in U.S. hospitals during 1991 by surveying 1,931 acute care institutions (19% of all acute care institutions). In addition, this report documents changes in HIV care in 124 teaching hospitals between 1988 and 1991. Of the 1,081 hospitals completing the 1991 survey (56%), 773 reported treating at least one HIV inpatient and a total of 58,211 inpatients. Northeastern and public hospitals provided significantly more care. Public-related payer sources financed almost 90% of care in public institutions and >60% in private institutions. Hospitals reported an average loss of $92,025 and an estimated total cost-based loss of $71.1 million among all responding institutions. The number of HIV inpatients increased 68% between 1988 and 1991. During these years, substantial increases in revenue and modest reductions in per patient use led to a decrease in total inpatient losses of $540,748 to $260,331 per hospital. Results show that HIV-associated inpatient care is extensive and increasing and that support for care has become a predominantly public sector responsibility. Teaching hospitals' increase in care suggests that they have become 'magnets' for patients with HIV-related disease. However, treatment economies and reimbursement rate improvements have worked to lower losses. Any HIV financing policies should work to balance support for non-hospital care with the continuing need for inpatient treatment.