Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, VA.
Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA.
J Acquir Immune Defic Syndr. 2023 Jan 1;92(1):1-5. doi: 10.1097/QAI.0000000000003105.
Retention in HIV care remains a national challenge. Addressing structural barriers to care may improve retention. We examined the association between physician reimbursement and retention in HIV care, including racial differences.
We integrated person-level administrative claims (Medicaid Analytic eXtract, 2008-2012), state Medicaid-to-Medicare physician fee ratios (Urban Institute, 2008, 2012), and county characteristics for 15 Southern states plus District of Columbia. The fee ratio is a standardized measure of physician reimbursement capturing Medicaid relative to Medicare physician reimbursement across states. Generalized estimating equations assessed the association between the fee ratio and retention (≥2 care markers ≥90 days apart in a calendar year). Stratified analyses assessed racial differences. We varied definitions of retention, subsamples, and definitions of the fee ratio, including the fee ratio at parity.
The sample included 55,237 adult Medicaid enrollees with HIV (179,002 enrollee years). Enrollees were retained in HIV care for 76.6% of their enrollment years, with retention lower among non-Hispanic Black (76.1%) versus non-Hispanic White enrollees (81.3%, P < 0.001). A 10-percentage point increase in physician reimbursement was associated with 4% increased odds of retention (adjusted odds ratio 1.04, 95% confidence interval: 1.01 to 1.07). In stratified analyses, the positive, significant association occurred among non-Hispanic Black (1.08, 1.05-1.12) but not non-Hispanic White enrollees (0.87, 0.74-1.02). Findings were robust across sensitivity analyses. When the fee ratio reached parity, predicted retention increased significantly overall and for non-Hispanic Black enrollees.
Higher physician reimbursement may improve retention in HIV care, particularly among non-Hispanic Black individuals, and could be a mechanism to promote health equity.
艾滋病毒护理的保留仍然是一个全国性的挑战。解决护理方面的结构性障碍可能会提高保留率。我们研究了医生报酬与艾滋病毒护理保留之间的关系，包括种族差异。
我们整合了个人层面的行政索赔（医疗保险分析提取，2008-2012 年）、州内医疗补助到医疗保险医生费用比率（城市研究所，2008 年、2012 年）以及 15 个南部州和哥伦比亚特区的县特征。费用比率是医生报酬的标准化衡量标准，它在州内捕捉医疗补助相对于医疗保险医生报酬的相对情况。广义估计方程评估了费用比率与保留（≥2 个护理标记符≥90 天分开在一个日历年）之间的关联。分层分析评估了种族差异。我们改变了保留的定义、子样本和费用比率的定义，包括费用比率的平价。
样本包括 55237 名成年医疗补助艾滋病毒感染者（179002 名感染者年）。感染者在艾滋病毒护理中保留了 76.6%的入组年，而非西班牙裔黑人（76.1%）比非西班牙裔白人感染者（81.3%，P<0.001）保留率较低。医生报酬增加 10 个百分点，保留的可能性增加 4%（调整后的优势比 1.04，95%置信区间：1.01 至 1.07）。在分层分析中，这种积极的、显著的关联发生在非西班牙裔黑人（1.08，1.05-1.12）中，但不在非西班牙裔白人感染者（0.87，0.74-1.02）中。在敏感性分析中，这些发现是稳健的。当费用比率达到平价时，总体上和非西班牙裔黑人入组者的预测保留率显著增加。
更高的医生报酬可能会提高艾滋病毒护理的保留率，特别是在非西班牙裔黑人中，并且可以成为促进健康公平的一种机制。
