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Recent Evidence on the Utilization and Costs of Health Services

David C. Hsia, JD, MD, MPH; John A. Fleishman, PhD; Jeffrey A. East; Fred J. Hellinger, PhD

Arch Pediatr Adolesc Med. 1995;149(5):489-496.

Abstract
Objective
To measure the utilization and costs of pediatric human immunodeficiency virus (HIV)–related health care services.

Design
Cohort survey.

Setting
Eight outpatient departments serving large numbers of HIV-infected children in five standard metropolitan areas with high prevalence of HIV-infected children.

Patients
One hundred forty-one HIV-seropositive children older than 15 months of age or children whose clinical conditions meet the definition of acquired immunodeficiency syndrome (AIDS) at any age who visited the selected providers during the second quarter of 1991.

Interventions
None.

Main Outcome Measures
Quarterly interview survey (via adult proxies) of health care services utilization during each preceding 3-month period, repeated six times between March 1991 and August 1992. Charge data were abstracted from inpatient, outpatient, home health care, and pharmacy bills.

Results
Children with AIDS averaged 1.4 hospitalizations, 16 inpatient days, two emergency department visits, 18 ambulatory care visits, 15 professional home health care visits, and one dental visit per year, generating an estimated $37 928 in annual charges. The HIV-infected children used fewer services, with annual charges of $9382.

Conclusions
We found lower utilization than reported in prior research on pediatric HIV and similar unit costs after inflation adjustment. Increasing experience in clinical management and expanded ambulatory care may have contributed to reductions in inpatient services utilization and total costs since the mid-1980s.

(Arch Pediatr Adolesc Med. 1995;149:489-496)

Author Affiliations
From the Agency for Health Care Policy and Research, Public Health Service, US Department of Health and Human Services, Rockville, Md (Drs Hsia, Fleishman, and Hellinger), and George Washington University Medical School, Washington, DC (Mr East).

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