COSTS AND OUTCOMES OF AIDS CARE - COMPARING A HEALTH MAINTENANCE ORGANIZATION WITH FEE-FOR-SERVICE SYSTEMS IN THE BOSTON HEALTH STUDY

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.