McKinney M M, Wieland M K, Bowen G S, Goosby E P, Marconi K M
HRSA/BHRD, Rockville, MD 20857.
Public Health Rep. 1993 Jan-Feb;108(1):4-11.
Title II of the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act of 1990 provides formula-based grants to States to help them improve the quality, availability, and organization of health care and support services for people with human immunodeficiency virus (HIV) infection. This article reviews State expenditures during the first year of CARE Act funding (April 1991-March 1992) within the context of Title II guidelines and the federally funded grant programs that preceded and helped shape Title II. The authors also discuss future challenges that require development of resources, the assessment of program impact, and the evaluation of the quality and appropriateness of HIV-related services. Ninety-one percent of the $77.5 million awarded to States during fiscal year 1991 went for the provision of medical and support services through HIV care consortia, drug reimbursement programs, home and community-based care programs, and health insurance initiatives. The remaining monies were used for planning, evaluation, and program administration. Forty States allocated $38.9 million for the establishment of HIV care consortia to assess service needs and to develop comprehensive continuums of health and support services in the areas most affected by HIV disease. Fifty States allocated an additional $28.3 million for the continuation or expansion of FDA-approved drug therapies for low-income people with HIV infection. Twenty-five States allocated $2.2 million for the provision of home- and community-based health services, and 16 States allocated $1.3 million for programs that help low-income people with HIV infection to purchase or maintain health insurance coverage.
1990年《瑞安·怀特艾滋病综合资源紧急救助（CARE）法案》第二章向各州提供基于公式的拨款，以帮助它们改善针对感染人类免疫缺陷病毒（HIV）者的医疗保健及支持服务的质量、可及性和组织架构。本文在第二章指导方针以及先于并助力形成第二章的联邦资助拨款项目的背景下，回顾了CARE法案第一年（1991年4月至1992年3月）的各州支出情况。作者们还讨论了未来的挑战，这些挑战需要资源开发、项目影响评估以及对HIV相关服务的质量和适宜性进行评价。1991财年拨给各州的7750万美元中，91%用于通过HIV护理联盟、药物报销项目、居家和社区护理项目以及医疗保险倡议提供医疗和支持服务。其余资金用于规划、评估和项目管理。40个州拨款3890万美元用于建立HIV护理联盟，以评估服务需求，并在受HIV疾病影响最严重的地区开发全面的健康和支持服务连续体。50个州额外拨款2830万美元用于继续或扩大为低收入HIV感染者提供的经美国食品药品监督管理局（FDA）批准的药物治疗。25个州拨款220万美元用于提供居家和社区健康服务，16个州拨款130万美元用于帮助低收入HIV感染者购买或维持医疗保险覆盖范围 的项目。
