Andrulis D P, McGregor C M, Weiss K B, Ramirez K L, Ginsberg C A, Shaw-Taylor Y
National Public Health and Hospital Institute, Washington, D.C. 20005, USA.
J Acquir Immune Defic Syndr Hum Retrovirol. 1995 Jun 1;9(2):193-203.
Hospitals are a major provider of resources for individuals with HIV-related conditions. With the changing nature of HIV, tracking the dependence on and impact of related care delivered in these institutions is critical to monitoring overall resource need. This report documents HIV inpatient care in U.S. hospitals during 1991 by surveying 1,931 acute care institutions (19% of all acute care institutions). In addition, this report documents changes in HIV care in 124 teaching hospitals between 1988 and 1991. Of the 1,081 hospitals completing the 1991 survey (56%), 773 reported treating at least one HIV inpatient and a total of 58,211 inpatients. Northeastern and public hospitals provided significantly more care. Public-related payer sources financed almost 90% of care in public institutions and > 60% in private institutions. Hospitals reported an average loss of $ 92,025 and an estimated total cost-based loss of $ 71.1 million among all responding institutions. The number of HIV inpatients increased 68% between 1988 and 1991. During these years, substantial increases in revenue and modest reductions in per patient use led to a decrease in total inpatient losses of $ 540,748 to $ 260,331 per hospital. Results show that HIV-associated inpatient care is extensive and increasing and that support for care has become a predominantly public sector responsibility. Teaching hospitals' increase in care suggests that they have become "magnets" for patients with HIV-related disease. However, treatment economies and reimbursement rate improvements have worked to lower losses. Any HIV financing policies should work to balance support for non-hospital care with the continuing need for inpatient treatment.
医院是感染艾滋病毒相关疾病患者的主要资源提供者。随着艾滋病毒性质的变化，追踪这些机构提供的相关护理的依赖性和影响对于监测总体资源需求至关重要。本报告通过对1931家急症护理机构（占所有急症护理机构的19%）进行调查，记录了1991年美国医院的艾滋病毒住院护理情况。此外，本报告记录了1988年至1991年间124家教学医院艾滋病毒护理的变化。在完成1991年调查的1081家医院（占56%）中，773家报告至少治疗过一名艾滋病毒住院患者，共有58211名住院患者。东北部医院和公立医院提供的护理显著更多。与公共相关的付款来源为公共机构近90%的护理和私立机构超过60%的护理提供资金。医院报告称，所有回复机构平均亏损92,025美元，基于成本的估计总亏损为7,110万美元。1988年至1991年间，艾滋病毒住院患者数量增加了68%。在这些年里，收入大幅增加，每位患者的使用量略有减少，导致每家医院的住院总亏损从540,748美元降至260,331美元。结果表明，与艾滋病毒相关的住院护理广泛且不断增加，护理支持已成为主要的公共部门责任。教学医院护理的增加表明它们已成为艾滋病毒相关疾病患者的“磁石”。然而，治疗经济性和报销率的提高有助于降低亏损。任何艾滋病毒融资政策都应努力在支持非住院护理与持续的住院治疗需求之间取得平衡。
