HEALTH-INSURANCE AND USE OF MEDICAL-SERVICES BY MEN INFECTED WITH HIV

Among 178 HIV-infected men from the San Francisco City Clinic Cohort ( SFCCC), we examined the association between health insurance and use o f outpatient services and treatment. For men with private insurance, w e also assessed the frequency of avoiding the use of health insurance. Men without private insurance reported fewer outpatient visits than m en with fee-for-service or managed-care plans. Use of zidovudine for e ligible men was similar for those with fee-for-service plans (74%), ma naged-care plans (77%), or no insurance (61%). Use of Pneumocystis car inii pneumonia prophylaxis was similar for those with fee-for-service (93%) and managed-care plans (83%) but lower for those with no insuran ce (63%). Of 149 men with private insurance, 31 (21%) reported that th ey had avoided using their health insurance for medical expenses in th e previous year. In multivariate analysis, the independent predictors of avoiding the use of insurance were working for a small company and living outside the San Francisco Bay Area. Having private insurance re sulted in higher use of outpatient services, but the type of private i nsurance did not appear to affect the use of service or treatment. Fea rs of loss of coverage and confidentiality may negate some benefits of health insurance for HIV-infected persons.