Ib. Wilson et al., COSTS AND OUTCOMES OF AIDS CARE - COMPARING A HEALTH MAINTENANCE ORGANIZATION WITH FEE-FOR-SERVICE SYSTEMS IN THE BOSTON HEALTH STUDY, Journal of acquired immune deficiency syndromes and human retrovirology, 17(5), 1998, pp. 424-432
Objective: A I-month observational cohort study was performed to compa
re the performance of one health maintenance organization (HMO) with t
wo fee-for-service (FFS) systems in Boston. Massachusetts in treating
255 patients with AIDS. Main Outcome Measures: Total I-month costs; co
st subcomponents, including inpatient, outpatient, home care, and zido
vudine costs; functional status (difficulties with activities of daily
living), and satisfaction with care. Results: Compared with FFS patie
nts, HMO patients were better educated. more often white, less often o
n Medicaid, and more often reported homosexual or bisexual behaviors a
s HIV risk factors (all factors, p = .001). Both groups had similar du
ration of AIDS, baseline hemoglobin levels, and leukocyte counts. Tota
l 4-month costs at the HMO were significantly lower than those in the
FFS settings ($4799 U.S., versus $8540 U.S.; p = .013), as were outpat
ient costs ($1131 U.S. versus $1614 U.S.; p = .001), after adjustment
for sociodemographic factors, baseline functioning, main HIV risk fact
or, and other clinical variables. Adjusted physical functioning (p = .
32) and patient satisfaction (p = .82). were similar between systems.
Conclusions: The HMO had significantly lower total costs without any o
bservable decrement in functional outcomes or patient satisfaction. Th
e largest component of these cost savings came from reduced spending o
n inpatient care, but the HMO also spent less on outpatient and home c
are. Better coordination of care at the HMO may have been responsible
for these lower costs.