The impact of ancillary services on primary care use and outcomes for HIV/AIDS patients with public insurance coverage.

To better understand the impact of ancillary services on access to primary care, utilization of health services, costs and health status of HIV/AIDS patients, we studied adult HIV/AIDS patients eligible for public insurance for low-income people (Medicaid) in eastern North Carolina. Using primary data from a 1997 survey of such patients linked to Medicaid claims, multivariate logit analysis was used to estimate the effect of receiving housing, legal services and substance abuse treatment and of self-reported failure to obtain transportation and child care services on: (a) adequacy and use of primary care; (b) CD-4 counts; (c) viral load; and (d) self-rated health status. Between two-thirds and four-fifths of patients needing ancillary services obtain them. Receipt of housing and legal services were found to have a positive relationship with access to primary care. Difficulties in obtaining transportation and receipt of substance abuse services had a negative relationship with receipt of adequate primary care. On balance, these findings provide some support for continued public funding for various ancillary services to improve patient access to needed primary care. At current funding levels, not all patients needing help appear able to obtain such services.