US 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-r elated conditions. With the changing nature of HIV, tracking the depen dence on and impact of related care delivered in these institutions is critical to monitoring overall resource need. This report documents H IV inpatient care in U.S. hospitals during 1991 by surveying 1,931 acu te 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 surv ey (56%), 773 reported treating at least one HIV inpatient and a total of 58,211 inpatients. Northeastern and public hospitals provided sign ificantly more care. Public-related payer sources financed almost 90% of care in public institutions and >60% in private institutions, Hospi tals reported an average loss of $92,025 and an estimated total cost-b ased loss of $71.1 million among all responding institutions. The numb er 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 car e is extensive and increasing and that support for care has become a p redominantly public sector responsibility. Teaching hospitals' increas e in care suggests that they have become ''magnets'' for patients with HIV-related disease. However, treatment economies and reimbursement r ate improvements have worked to lower losses. Any HIV financing polici es should work to balance support for non-hospital care with the conti nuing need for inpatient treatment.