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Suggested Citation:"Index." Institute of Medicine. 2005. Public Financing and Delivery of HIV/AIDS Care: Securing the Legacy of Ryan White. Washington, DC: The National Academies Press. doi: 10.17226/10995.
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Index

A

Access to care

CARE Act programs, 12–13, 17

case management and, 130–131

current system, 5, 13, 268–269, 271

demographic disparities, 129–130

goals, 6–7, 14–15, 16, 33, 36, 50, 134

HAART, 11–13, 14, 129–130, 136, 181, 218–223

insurance access and, 272–274

mental illness and, 55–56, 252, 258, 259–260, 263

outreach to improve, 304

provider participation in federal programs and, 12, 14, 19, 111, 136, 203

public perception, 27–28

shortcomings of current system, 6, 11–12, 14, 19, 135–136

state-to-state disparities, 11, 14, 75, 110, 112, 113, 114–117, 118, 119–122, 284–290, 291, 292, 300, 326

See also Barriers to care

Accountability, 13, 14, 136

in Centers of Excellence, 171–174

criteria for assessing programs, 142

goals, 15, 134

in Medicare, 146

Acute infection

care trends, 6

clinical features, 40

Adherence to HAART

clinical significance, 5, 9, 46, 47, 63

current rate, 46

determinants of, 46, 47–49

drug resistance and, 9, 46–47

mental illness and, 47, 49, 56–57, 91–93, 254, 256–257, 260

patient–provider relationship and, 47, 49, 163

predictive factors, 49

requirements for success, 9, 46, 162–163

substance abuse and, 59, 91–93, 320–321

AIDS Drug Assistance Program, 109, 299

barriers to access, 13, 118, 145, 300

drug purchases, 20, 125, 204, 270, 306

eligibility, 13, 17, 197

HIV-CCP and, 197–198, 207

purpose, 80, 299

resource allocation, 13, 145, 248, 299

spending, 80, 84, 297–298

AIDS Education and Training Centers, 29, 81, 190, 300

Alternative delivery and financing systems, 195

assessment criteria, 16, 142, 214

Suggested Citation:"Index." Institute of Medicine. 2005. Public Financing and Delivery of HIV/AIDS Care: Securing the Legacy of Ryan White. Washington, DC: The National Academies Press. doi: 10.17226/10995.
×

block grant program, 153–157

enhanced or expanded Medicaid, 148–153, 195, 213–214, 230, 231

expanded CARE Act programs, 144–145

goals, 16, 141–142

HAART modeling for evaluation of, 214–216

inputs for modeling, 217–225

Medicare expansion, 145–148, 195

projected enrollment, 224–225

projected utilization, 223–224

prospects, 174–175

range of, 15–16, 141, 142, 213

sensitivity analyses, 234–243

state participation, 142–144

See also HIV Comprehensive Care Program

American Public Health Association, 47

Antiretroviral drugs

access disparities, 129–130

alternative therapies, 46

for children, 90

costs, 20, 21, 204, 270

effectiveness, 42, 43–44

technical evolution, 42–43

See also Highly active antiretroviral therapy

Anxiety disorders

adherence to HIV treatment and, 91

prevalence, 251, 253

risk behavior and, 54–55, 255

Assessment

adherence prediction, 49

depression, 55

insurance status and time of diagnosis, 274

role of primary care, 98

Asymptomatic infection, 40–41

At-risk populations, 37

implications for health care delivery, 50

trends, 9, 10, 38, 50, 63

Automobile restraints, 187

Awareness of HIV status, 156, 181, 218, 226

AZT, 42–43, 269, 299

B

Bailey Boushay House, 333

Balanced Budget Act, 18, 197

Barriers to care

in CARE Act programs, 118–122, 300

conflicting goals among programs, 133–134

coordination among programs and, 127–129, 136, 268, 305–306, 328

cost of care, 132–133

in current system, 6, 14, 19, 27, 133–134, 280–283, 304–307

in Medicaid, 12, 17, 109–114, 132–133, 291–293

in Medicare, 117, 295–297

mental illness, 55–56, 131

in private insurance programs, 107–109, 301, 302–303

provider reimbursement, 19, 111, 325–326

sources of, 129

for substance abusers, 58–59, 313, 318–323, 325–327, 330–332

for women of color, 59

See also Access to care

Bipolar disorder, 251

Block grants

advantages, 154

disadvantages, 155–157

structure, 153–154

substance abuse treatment, 324

C

Cancer, 44

Candidiasis, 42

Capitation rates, 111, 114

CARE Act. See Ryan White CARE Act

Care coordination model of service, 170

Care-seeking behavior

cost of care and, 132

substance abuse and, 58, 94, 319

Case management, 127

benefits, 96, 130–131

CARE Act coverage, 298–299

Centers of Excellence model, 170

definition, 96

delivery models, 96

HAART utilization and, 224

modeling service needs, 223–224

CD4 lymphocyte levels

course of HIV, 41, 42

depression effects, 93–94

HAART guidelines, 44, 89

Suggested Citation:"Index." Institute of Medicine. 2005. Public Financing and Delivery of HIV/AIDS Care: Securing the Legacy of Ryan White. Washington, DC: The National Academies Press. doi: 10.17226/10995.
×

CD8 lymphocyte levels, depression effects, 93–94

Center for Substance Abuse Treatment, 324

Centers for Medicare & Medicaid Services, 114, 128–129, 233–234

Centers of Excellence for HIV care

accountability mechanisms, 171–174

existing programs, 168–169

features, 168

functions, 7, 170–171

HIV-CCP demonstration project, 180, 206

reimbursement practice, 168, 169, 171–174, 188

structural models, 169–170

Childcare services, 322

Children and adolescents

CARE Act services, 80–81, 202

HIV transmission at childbirth, 19, 90

HIV treatment, 90–91

Medicaid coverage, 278

mental illness among, 61–62, 252

sexual abuse as HIV risk factor, 255

unsupervised youths, 61–62

Chronic care

clinical model, 162–164

definition of chronic illness, 161

HIV/AIDS requirements, 161–162

implications for health care delivery, 6, 12, 31, 88, 161–164, 165

integrated and coordinated model, 165–168

trends, 6, 12, 63, 88, 100

Colorectal cancer screening, 186–187

Community health centers, 303–304

Co-morbidity

among HIV-infected youth, 61–62

HIV-CCP coverage, 201, 202

infections, 59–60.

See also Opportunistic infection

recommendations for federal care program, 19

social conditions as, 54, 60–63

trends, 5–6, 10, 38–39

types of, 52–54

See also Mental illness;

Substance abuse;

specific disorders

Consolidate Omnibus Reconciliation Act, 109, 302

Coordination among HIV/AIDS programs

need for, 127–129, 268

research needs, 305–306

Coronary angioplasty, 187

Cost effectiveness

current HIV care, 270

HAART, 89, 179, 196

HIV-CCP, 16, 22–23, 24, 179, 180–181, 185–188, 231–232

program evaluation methodology, 185–186, 214

Cost of care

as barrier to care, 132–133

buy-in provisions, 18, 111

care-seeking behavior and, 132

drugs, 19–21, 203–205, 270, 306

enhanced Medicaid program, 234

goals, 134

HAART, 23, 179, 185, 196, 204–206, 223, 269–270

HIV care as portion of all health care spending, 270

HIV-CCP budget, 233–234

inputs for modeling alternative programs, 217–218, 223–224, 234–243

preventive intervention outcomes, 193

private insurance premiums, 107–108, 302

provider reimbursement rates, 111

psychopharmacotherapy, 262

recommendations for federal program, 21

spend-down eligibility in federal programs, 18, 326

subsistence purchases and, 131

substance abuse treatment, 327–328

trends, 276

for uninsured HIV/AIDS patients, 189

Course of disease, 40–42

disease state-transition model, 215

initiation of HAART, 226–227

insurance coverage and, 87

insurance status and time of diagnosis, 274

mental illness effects, 93–94, 257

oral manifestations, 98

D

Data collection

on CARE Act program performance, 13, 14, 122–123, 126–127, 136, 145

current inadequacies, 13, 14, 136

Suggested Citation:"Index." Institute of Medicine. 2005. Public Financing and Delivery of HIV/AIDS Care: Securing the Legacy of Ryan White. Washington, DC: The National Academies Press. doi: 10.17226/10995.
×

HAART use and need, 218–223

HIV population characteristics, 218

inputs for modeling alternative programs, 217–225

Medicare, 146

privacy and confidentiality issues, 196

records management in Centers of Excellence, 169–170

on substance abuse, 315–317

Delivery of care

case management services, 96

consideration of substance abusers in policy planning, 314

coordination among programs, 124, 125, 127–129, 268, 305–306, 328

current system, 5–6, 12, 34, 63, 99, 100

demographic factors, 50

financing of care and, 10

functions of system, 167

future challenges, 36, 38–39

goals, 14–15, 16, 33, 36, 88, 133–134, 161, 178

historical development, 87–88

integrated and coordinated model, 165–167

organizational structure, 167–168

primary care, 98–99

prospects for reform, 174–175

shortcomings of current system, 13–14, 107, 134–136, 165, 167, 194–195

system evaluation, 32

trends, 6, 12, 36

See also Alternative delivery and financing systems;

specific programs

Demographic patterns

access disparities, 129–130, 305

geographic distribution, 51–52

implications for service delivery, 50

infection rate, 9–10, 38, 51

insurance access, 272

mental health care utilization, 258

mental illness risk, 251

mortality, 9

trends, 50, 51–52, 63, 194–195, 270, 307

See also Racial/ethnic minorities;

Women

Dental health. See Oral health

Dental Reimbursement Program, 30, 81

Department of Defense, 19, 203, 304

Department of Veterans Affairs, 33, 282–283, 303, 327

drug purchases, 19, 20, 203

Depression

adherence to HIV treatment and, 56–57, 91, 256

HIV progression and, 93–94

identification, 55

immune function and, 257

prevalence, 251, 253

risk behavior and, 54–55, 255

Diabetes, 47, 162

Drug-resistant viral strains

adherence and, 5, 9, 46–47

screening for, 89

trends, 9, 47

Dysthymia, 253

E

Early Treatment for HIV Act, 292

Education and training of health providers

CARE Act programs, 29, 81, 190, 300

care for substance abusers, 321

in Centers of Excellence, 168

Medicaid providers, 111–114

Efficiency of service delivery, 134.

See also Cost effectiveness

Eligibility, 278, 280–283

alternative block grant program, 153–157

asset testing for, 198–199

buy-in provisions, 18

CARE Act, 17, 82, 144–145, 196, 197, 207, 249, 298

criteria for assessing programs, 142

current status, 17

expansion of Medicaid eligibility, 149–153, 217

HIV-CCP, 7, 18, 157–158, 178, 179, 181–182, 190, 196–201, 207, 217, 226

Medicaid, 17, 18, 75–76, 109, 114, 196, 197, 201, 278, 279–290, 291–292, 305, 325

Medicare, 78, 145–146, 147, 294–295, 305

modeling prospective enrollment in alternative programs, 224–225

mortality outcomes, 130

Suggested Citation:"Index." Institute of Medicine. 2005. Public Financing and Delivery of HIV/AIDS Care: Securing the Legacy of Ryan White. Washington, DC: The National Academies Press. doi: 10.17226/10995.
×

recommendations for improving access, 18

Social Security Disability Insurance, 294

spend-down provisions, 18, 197–198, 279, 326

substance abuse treatment, 325

Supplemental Security Income, 279, 325

Eligible Metropolitan Areas, 119, 122–123, 246–247, 298–299, 329, 331

Emergency room admission, 59

current utilization, 99

modeling service needs, 223

substance abuser care-seeking behaviors, 319

Entitlement programs, 73, 153, 156, 276

Evidence-based practice, 163

F

Federal Ceiling Price, 20, 21

recommendations for HIV-CCP, 179–180, 203, 205

Federal Employee Health Benefits, 304

Federal programs for HIV/AIDS care, 278, 280–283, 328

barriers to access, 132, 133–134

benefits, 280–283

Centers of Excellence oversight, 174

current spending, 73, 75, 78, 188, 274–277

eligibility, 280–283

financing mechanisms, 73, 100

goals, 8, 133–134

mandatory vs. discretionary spending, 276

origins and development, 8

problems of federal–state partnership, 6, 11, 14, 136

recommendation for new program, 6–7, 16.

See also HIV Comprehensive Care Program

substance abuse treatment in, 95

See also specific programs

Federal Supply Schedule, 20, 21

recommendations for HIV-CCP, 179–180, 203, 205

Fee-for-service care, 12

Financing system

Centers of Excellence, 171–174

community-based services, 304

coordination among programs, 305–306

criteria for assessing programs, 142

current HIV spending, 73, 188, 274–277

current system, 5, 11, 73, 100, 216, 268

delivery system and, 10

federal block grant program, 153–157

geographic variation, 122

goals, 14–15, 16, 178

insurance coverage distribution, 271–274

prevention services, 306–307

problems of federal-state partnership, 6, 11, 14, 136

shortcomings of current system, 6, 11, 14, 134–136, 194–195, 268–269, 304–307

substance abuse services, 323–326, 327–328

See also Alternative delivery and financing systems;

Cost of care;

specific programs

Fusion inhibitors, 37

G

Geographic distribution

CARE Act spending, 122

disease prevalence, 51–52

drug use patterns, 316

uninsured population, 129

Guidelines for the Use of Antiretroviral Agents in HIV-Infected Adults and Adolescents, 44–46, 89

H

HAART. See Highly active antiretroviral therapy

Health Insurance Portability and Accountability Act, 85–87, 107, 108, 301–303

Health Resources and Services Administration, 7, 165

Hepatitis C, 42, 59–60

Heterosexual transmission trends, 10, 51

Highbridge Woodycrest, 334

Highly active antiretroviral therapy (HAART), 100

access under HIV-CCP, 159, 178–179, 182–183, 217, 226–230

adverse effects, 44

Suggested Citation:"Index." Institute of Medicine. 2005. Public Financing and Delivery of HIV/AIDS Care: Securing the Legacy of Ryan White. Washington, DC: The National Academies Press. doi: 10.17226/10995.
×

assessment for, 49

cost-effectiveness, 89, 179, 196

costs, 20–21, 23, 159, 179, 185, 196, 204–206, 223, 269–270

criteria for evaluating alternative delivery and financing systems, 214–215

current access, 11–13, 14, 129–130, 136, 181, 214–215, 218–223, 226

disease status of recipients, 226–227

dosing schedule, 48–49

drug interactions, 127, 320

effectiveness, 5, 8, 31, 37, 43–44, 130, 184–185

implications for care delivery system, 6, 31, 36, 39, 88

income levels of recipients, 222

insurance status of recipients, 181, 222

Medicaid coverage, 77, 217, 230

in pregnancy, 90

requirements for clinical effectiveness, 18

substance abusers and, 320

transmission risk and, 8, 37–38, 135

treatment guidelines, 44–46, 89

viral resistance to, 9

See also Adherence to HAART

High-risk pools, 304

HIV/AIDS Integrated Services Project, 306

HIV/AIDS Mental Health Services Demonstration Program, 95

HIV Comprehensive Care Program, 213

administrative structure, 157, 159

benefit package, 18–19, 157, 158, 179, 186, 201–202, 215–216, 217

Centers of Excellence demonstration project, 180, 206

cost-effectiveness, 22–23, 24, 179, 180–181, 185–188

disadvantages, 159–160

drug purchases, 21, 159, 179–180, 203–206

eligibility, 7, 18, 157–158, 178, 179, 181–182, 190, 196–201, 207, 217, 226

financing, 157, 158–160, 196, 217, 233–234

goals, 6–7

HAART access and use under, 159, 178–179, 182–183, 217, 226–230

inputs for modeling, 217–225

maintenance of effort requirements, 160

morbidity and mortality outcomes, projected, 16, 22, 179, 183–184, 225, 230–231

prevention effect, 192–193

private insurance market effects, 181, 199–200

projected enrollment, 22, 178, 182–183, 190, 217, 224–225, 226

projected service utilization, 217–224

projected spending, 23, 160, 179, 188–189, 233–234

provider payment, 19, 158, 179, 185, 188, 202–203, 217

quality of care goals, 21

rationale, 16, 23–24, 33, 158–159, 179, 193–194, 208–209

recommendation for establishment of, 17, 179, 194–196

Ryan White CARE Act and, 21–22, 160, 180, 189–191, 206–208

state participation, 159–160, 195, 196, 234

Home and community-based services, 223, 303–304

CARE Act coverage, 329

Medicaid coverage, 114, 290–291

Homelessness, 61

Housing Opportunities for Persons with AIDS, 276

I

Immigrant population, 62, 200

Immunophysiology

AIDS, 41–42

chronic stage infection, 40–41

co-morbid disease infection, 60

depression effects, 257

HAART, 44–45

primary infection, 40

tuberculosis risk, 60

Incarcerated populations, 62–63, 200–201, 326

Incidence

current rate, 5, 7–8, 27, 36–37

demographic patterns, 9–10, 38, 307

trends, 9–10, 37–38, 194–195, 307

Suggested Citation:"Index." Institute of Medicine. 2005. Public Financing and Delivery of HIV/AIDS Care: Securing the Legacy of Ryan White. Washington, DC: The National Academies Press. doi: 10.17226/10995.
×

L

Low-income population

care delivery system goals, 14–15

challenges for service delivery, 50

crowd-out response to government programs, 181

current estimates, 218, 270

current HIV/AIDS care system, 34

definition, 197

eligibility for federal care programs, 17, 18, 197

eligibility for Medicaid HIV benefits, 109, 111, 279, 290

expansion of eligibility for Medicaid

HIV benefits, 149–153

HAART access among, 222

HIV-CCP eligibility, 179, 181–182, 196, 197–199

infection risk, 38

mental illness risk, 251

poverty level, 181, 196

recommendations for CARE Act programs, 22

social co-morbidities, 54, 60–61

substance abuse treatment access among, 58–59

M

Mammography, 187

Managed care, 117

Centers of Excellence model, 170

Medicaid, 111–113, 293

Medicaid

barriers to access, 12, 17, 109–114, 132–133, 272–273, 291–293, 305

benefits, 76–77, 290–291

capitation rates, 111, 114

case management services, 96

community-based services, 304

coordination with other programs, 128–129

coverage for privately-insured individuals, 199

coverage for working individuals, 109–111, 291–292

current participation, 10, 73, 75, 129, 218, 271, 272, 274, 278–279

definition of “disability,” 279

demographic patterns in HIV care, 272

dental services, 130

drug purchases, 20, 21, 203–204, 270, 293, 306

dual enrollment, 271, 294

eligibility for AIDS/HIV care, 17, 18, 75–76, 109, 114, 149–153, 196, 197, 201, 278, 279–290, 291–292, 305

enhanced or expanded models, 15–16, 141, 148–153, 195, 213–214, 217, 230, 231, 234

managed-care services, 111–113, 293

mental illness treatment, 115

performance evaluation, 32

preventive interventions, 97

primary care services, 98

provider participation and reimbursement, 12, 19, 111, 114, 202–203, 325–326

quality of care, 273–274

role in HIV care system, 7

Section 1115 waivers for HIV care prior to disability, 7, 15, 109, 111, 149–150, 291–292, 305

spending, 75, 274–275, 276, 279, 328

state cost control strategies, 293

state-to-state disparities, 11, 14, 75, 110, 112, 113, 114–117, 284–290, 291, 292, 305

strategies for improving service delivery, 114

structure, 75, 278

substance abuse treatment, 95, 115, 325–326

Medicaid Managed Care Organizations, 205

Medicare

access, 19

barriers to access, 117, 295–297, 305

benefits, 79, 117, 147–148, 295

coverage, 77–78, 293

current enrollment, 10, 73, 78, 129, 218, 271, 272, 293–294, 328

dual enrollment, 271, 294, 296–297

eligibility, 78, 145–146, 147, 294–295, 305

expansion of, to improve care, 141, 145–148, 195

financing sources, 146

prescription drug coverage, 79, 147–148, 294–295, 296–297, 305, 306

Suggested Citation:"Index." Institute of Medicine. 2005. Public Financing and Delivery of HIV/AIDS Care: Securing the Legacy of Ryan White. Washington, DC: The National Academies Press. doi: 10.17226/10995.
×

program accountability, 146

project growth in enrollment, 78, 294

provider participation and reimbursement, 12, 19, 111, 146, 203

spending, 78, 274–275, 276, 294, 328

strategies for improving service delivery, 117

utilization patterns, 127–128

Medicare Prescription Drug, Improvement and Modernization Act, 147, 294–295

Medigap policies, 117, 296

Mental illness

access to care, 252, 263

adherence to HIV treatment and, 47, 49, 56–57, 91–93, 254, 256–257, 260

among HIV-infected youth, 61–62

barriers to care, 55–56, 131, 258, 259–260

challenges for service delivery, 50

clinical features, 251

co-morbid substance abuse, 251, 327

disability outcomes, 251, 252

HAART utilization and, 224

HIV-CCP coverage, 201

HIV detection in people with, 55, 258

HIV risk, 54–55, 94, 252–253, 254–256

impact on course of disease, 93–94, 257

implications for HIV treatment, 95, 250, 261–263

Medicaid coverage, 115

modeling service needs, 223–224

mortality, 251–252

pharmacotherapy, 261–262

prevalence, 54, 250, 251, 252–253

severe forms, 252

socioeconomic status and, 251

standard of HIV care, 10, 19

stigmatization and discrimination, 260

trends, 10, 253–254

Montefiore Substance Abuse Treatment Center, 333

Mortality

cause of death in HIV disease, 42

co-morbid depression, 94

course of HIV, 42

current rate, 5, 7–8, 37

demographic patterns, 9, 51

HAART outcomes, 5, 8, 37, 130, 184

HIV-CCP goals, 16

HIV-CCP projected outcomes, 22, 179, 183–184, 230–233

insurance coverage and, 130

mental illness, 251–252

obstacles to greater reduction, 5–6, 12

treatment effectiveness, 43

trends, 8, 42

Multidisciplinary treatment approach, 163–164

N

National health insurance, 33

Natural history. See Course of disease

Nonmedical services, 190

Medicare coverage, 117

modeling service needs, 223

NorthSTAR Behavioral Health Pilot Program, 334

O

Obstetric care, 19, 90, 201, 223

Omnibus Budget Reconciliation Act, 203–204, 279

Opportunistic infection, 42, 89–90

guidelines for prevention and treatment, 90

HAART effectiveness, 44

modeling service needs, 223

types of, 90

Oral health

access to care, 130

CARE Act provisions, 30, 81, 98–99, 190, 202, 299

disease progression, 98

Medicaid services, 130

modeling service needs, 223

primary care, 98

Origins of HIV, 40

P

Panic disorder, 91, 253

Patient–provider relationship

discrimination against client with mental illness, 260

HAART adherence and, 47, 49, 163

substance abusing patients, 321–322

Suggested Citation:"Index." Institute of Medicine. 2005. Public Financing and Delivery of HIV/AIDS Care: Securing the Legacy of Ryan White. Washington, DC: The National Academies Press. doi: 10.17226/10995.
×

Pneumonia, 42

Posttraumatic stress disorder, 253, 255

Pregnancy

HAART and, 90

HIV transmission prevention in, 19, 90–91

Prescription drugs

CARE Act coverage, 118, 204

costs, 19–20, 270, 306

goals for federal purchasing, 7

HIV-CCP drug purchases, 21, 159, 179–180, 203–206

Medicaid benefits, 76–77, 113, 203–204, 290, 291, 293, 328

Medicaid spending, 270

Medicare benefits, 79, 117, 147–148, 294–295, 296–297, 305

pharmacy assistance programs, 304

psychotropic medications, 261–262

research and development, 20–21

See also AIDS Drug Assistance Program;

Highly active antiretroviral therapy

Prevalence

CARE Act EMA eligibility, 246–247

childhood sexual abuse, 62, 255

co-morbid disease infection, 60

co-morbid mental illness, 54, 252–253

co-morbid substance abuse, 57–58, 253, 316–317

current estimates, 218, 226

geographic distribution, 51–52

homelessness, 61

mental illness, 54, 250, 251

socioeconomic distribution, 270

trends, 37–38

Preventive interventions

among HIV-positive individuals, 97

antiretroviral therapy, 97

financing, 306–307

HIV-CCP coverage, 201, 202

HIV-CCP effects, 192–193

with mentally ill individuals, 262–263

Primary care

access, 10

advantages of health care delivery in, 98

CARE Act provisions, 98–99, 118, 126

HIV-CCP coverage, 201

Medicaid coverage, 98

role in HIV care system, 98

scope of services, 98

Primary infection, 40

Prisons. See Incarcerated populations

Privacy and confidentiality issues, 196

Private insurance, 33

anti-discrimination protections, 301–302

barriers to care, 107–109, 301, 302–303

CARE Act purchases, 108–109, 302

COBRA extensions, 302

consumer costs, 107–108

coverage over course of disease, 87

crowd-out response to government programs, 181, 199–200

current coverage, 10, 73, 85, 100, 108, 129, 218, 271, 272, 274, 301

demographic patterns in HIV care, 272

denial of service, 108, 301

HIV-CCP eligibility and, 199

Medigap policies, 117, 296

portability protections, 301

regulation, 85–87, 108, 301–302

state-by-state variation in care, 108

PROTOTYPES, 332–333

Public perception and understanding

of HIV/AIDS care, 27–28

stigmatization of HIV-infected persons, 260

Q

Quality-adjusted life years

evaluation of alternative care systems, 22, 215, 216

HIV-CCP goals, 16

HIV-CCP projected outcomes, 22–23, 179, 184–185, 186–188, 231–233

Quality of care

CARE Act programs, 118, 123

current system, 305

goals, 15, 134, 164–165

HIV-CCP goals, 21

insurance access and, 273–274

in managed-care organizations, 111–113

Medicaid providers, 111–114

mental illness and, 260, 262–263

promptness of diagnosis, 274

in rural areas, 99

specialists in HIV care, 113, 114

strategies for improving, 164–165

substance abuse and, 319–320

Suggested Citation:"Index." Institute of Medicine. 2005. Public Financing and Delivery of HIV/AIDS Care: Securing the Legacy of Ryan White. Washington, DC: The National Academies Press. doi: 10.17226/10995.
×

R

Racial/ethnic minorities, 38

barriers to care, 59, 129–130, 131, 132–133

CARE Act services, 82, 247, 249

co-morbid disease infection, 60

HIV risk, 9, 38

infection patterns, 51, 307

insurance access and utilization, 272

mental health care utilization, 258

mental illness risk, 251

mortality patterns, 9

substance use in HIV transmission among, 57, 315

Reimbursement

alternative block grant program, 156

carve-out programs, 114, 170

Centers of Excellence, 168, 169, 171–174

criteria for assessing programs, 142

disincentive programs, 173–174

HIV-CCP, 19, 158, 179, 185, 188, 202–203, 217

Medicaid, 12, 14, 19, 114, 132–133, 202–203, 293, 325–326

Medicare, 12, 19, 111, 146, 203

obstacles to access, 12, 14, 19, 132–133, 136, 203, 293

risk-adjusted capitation, 114

state-to-state variation, 326

Research and development in pharmaceutical industry, 20–21

Rivington House, 334

Rural areas, 323

Centers of Excellence in, 173

quality of care in, 12, 99

substance abuse treatment in, 326

Ryan White CARE Act, 7, 11, 28

barriers to care, 12–13, 118–122, 300

benefits, 202, 298–300

case management services, 96

clients, 30, 35, 81–82, 298

coordination with other programs, 124, 125, 128–129

dental program, 30, 81, 98–99, 190, 202, 299

early intervention services, 80, 119, 202, 207–208, 299

education and training centers, 29, 81, 190, 300

effectiveness, 31–32

eligibility, 17, 82, 144–145, 196, 197, 207, 298

Eligible Metropolitan Areas, 119, 122–123, 298–299, 329, 331

emerging communities awards, 249, 299

expansion of, to improve care, 141, 144–145

funding, 118, 145, 297–298, 300, 328

HIV-CCP and, 21–22, 160, 180, 189–191, 206–208

HIV treatment evolution and, 30–31

performance evaluation, 13, 14, 122–123, 126–127, 136, 145

planning bodies, 13, 84–85, 123–127, 144, 329, 331

primary care services, 98–99, 118, 126

private insurance purchases under, 108–109, 302

purpose, 8, 11, 28–30, 50, 79, 268, 297

services and components, 29–30, 80–81, 82–84

spending, 80, 81, 119, 125, 276, 298, 299, 300

state and local administration, 13, 80, 144, 145, 248, 298, 299, 329

state-to-state disparities, 17, 118, 119–122, 144–145, 284–290, 298, 300, 305

substance abuse treatment, 95, 314, 328–331, 334–335

Title I, 13, 29, 80, 82, 84, 85, 96, 119, 123, 125, 145, 190, 207, 246–247, 298–299, 328–330

Title II, 13, 29, 80, 82–84, 96, 108–109, 119, 122, 190, 207, 248–249, 299, 328–330

Title III, 29, 80, 119, 190, 202, 207–208, 299

Title IV, 29, 80–81, 119, 190, 202, 299

See also AIDS Drug Assistance Program

Ryan White Planning Councils and Consortia, 123–127

S

Schizophrenia, 251, 253, 255, 261

Screening

cost-effectiveness, 186–187

for drug-resistant viral strains, 89

HIV detection in people with mental illness, 55, 258

Suggested Citation:"Index." Institute of Medicine. 2005. Public Financing and Delivery of HIV/AIDS Care: Securing the Legacy of Ryan White. Washington, DC: The National Academies Press. doi: 10.17226/10995.
×

incarcerated persons, 63

prenatal, 90–91

rapid testing, 37

Sensitivity analysis, 234–243

Settings for care

current utilization, 12, 99, 100

insurance coverage and, 10, 268

for substance abusers, 59, 319–320

trends, 6, 87–88, 165

Sexual abuse

HIV transmission risk and, 255

prevalence, 62, 255

Sexual behavior

HAART and, 135

mental illness and, 54–55, 94, 254–256

prevention of transmission-risk behaviors, 97

prior sexual abuse and, 255

substance use and, in HIV transmission, 315

Sexually transmitted diseases, co-morbid, 59–60

Social co-morbidity, 54, 60–63

Social Security Disability Insurance

eligibility, 294

Medicare eligibility and, 78, 294

spending, 275–276

Social services access, 10

Special Projects of National Significance, 29, 81, 190, 300

Standard of care, 10, 88–89, 100

alternative block grant program, 155–156

criteria for assessing programs, 142

current delivery system, 6

HIV-CCP, 158, 179, 201–202

recommendations for federal program, 18–19

State Children’s Health Insurance Program, 142, 153–154, 155, 200, 201

State governments

alternative block grant program, 153–157

CARE Act administration, 80, 119, 122, 248, 298, 299

drug purchases, 203–204

eligibility for AIDS/HIV care, 17

expansion of Medicaid eligibility, 149–153

health care for incarcerated persons, 200–201

HIV care spending, 276, 279, 328

in HIV-CCP, 17, 157–158, 159–160, 189, 195, 196, 234

inadequacies of current care system, 6, 7

insurance regulation, 108

Medicaid administration, 11, 75, 76–77, 279–290, 291, 328

problems of federal–state partnership, 6, 11, 14, 136

purchase of private insurance by, 108

role in alternative delivery and financing systems, 142–144

substance abuse treatment programs, 323–324

State-to-state variation in services

CARE Act programs, 118, 119–122, 144–145, 284–290, 298, 300, 305

current system, 6, 7, 305

Medicaid programs, 11, 14, 75, 110, 112, 113, 114–117, 284–290, 291, 305

private insurance, 108

reimbursement policies, 326

Stigmatization, 260, 318

Substance abuse

abuser attitudes toward health care, 321–322

among HIV-infected populations, 57–58, 61–62, 253, 316–317

barriers to HIV/AIDS care, 313, 318–323, 330–332

CARE Act provisions, 314, 328–331, 334–335

care-seeking behavior and, 58, 94, 319

challenges for service delivery, 50, 57, 58–59

co-morbid mental illness, 251, 327

considerations in HIV policy planning, 314

current research base, 315–317

current treatment system, 323–332

denial of services based on, 322

effective programs, 331–335

funding for treatment services, 323–326, 327–328

HAART utilization and, 224, 320

hepatitis infection and, 60

HIV-CCP coverage, 201

HIV course and, 91, 93–94

HIV transmission and, 57, 94, 313, 315

Medicaid coverage, 115, 325–326

Suggested Citation:"Index." Institute of Medicine. 2005. Public Financing and Delivery of HIV/AIDS Care: Securing the Legacy of Ryan White. Washington, DC: The National Academies Press. doi: 10.17226/10995.
×

modeling service needs, 223–224

patterns, 315–316

provider attitudes, 321

recommendations for federal care program, 19

service needs of HIV-infected substance abusers, 91, 95, 317–318

standard of HIV care, 10, 19

syringe exchange program, 314

treatment adherence and, 47, 49, 59, 91–93, 320–321

treatment capacity, 326–327

treatment for, 322–323

Substance Abuse and Mental Health Services Administration, 95, 315–316, 324

Substance Abuse Prevention and Treatment Block Grants, 95

Supplemental Security Income, 18, 76, 112, 197, 275–276, 279, 305, 325

Syringe exchange program, 314

T

Teaching hospitals, 99

Temporary Assistance for Needy Families, 112

Testing. See Screening

Therapeutic relationship. See Patient–provider relationship

Ticket to Work/Work Incentives Improvement Act, 109–111, 114, 291–292, 305

Transmission, HIV

among injection drug users, 57

HAART therapy and, 8, 37–38, 135

heterosexual, 10, 51

HIV-CCP effects, 192–193

mental illness and, 54–55, 94, 252–253, 254–256

mother-to-child, 90–91

projections, 37–38

stage of disease and risk of, 10, 41,

substance abuse and, 57, 94, 313, 315

See also Incidence;

Preventive interventions

Tuberculosis, 42, 60

U

Underinsured/uninsured population, 33

among individuals with HIV/AIDS, 11, 100, 129, 226, 271, 272, 274

CARE Act coverage, 79, 82, 297

costs of HIV care, 189

demographic patterns, 272

geographic distribution, 129

HAART access and utilization, 181

HIV-CCP projections, 189

infection trends, 38, 50

settings for care, 10, 268

substance abuse treatment access among, 58–59

V

Viral load, 41–42, 43

depression effects, 93–94

W

Women

barriers to care, 59, 322

CARE Act services, 80, 82, 202

depression risk, 251

infection patterns, 9–10, 51

insurance access and utilization, 272

obstetric care, 90

substance use in HIV transmission among, 315

Z

Zidovudine, 90

Suggested Citation:"Index." Institute of Medicine. 2005. Public Financing and Delivery of HIV/AIDS Care: Securing the Legacy of Ryan White. Washington, DC: The National Academies Press. doi: 10.17226/10995.
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Public Financing and Delivery of HIV/AIDS Care: Securing the Legacy of Ryan White Get This Book
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Each year it is estimated that approximately 40,000 people in the U.S. are newly infected with HIV. In the late 1990s, the number of deaths from AIDS dropped 43% as a result of highly active antiretroviral therapy. Unfortunately, the complex system currently in place for financing and delivering publicly financed HIV care undermines the significant advances that have been made in the development of new technologies to treat it. Many HIV patients experience delays in access to other services that would support adhering to treatment. As a result, each year opportunities are missed that could reduce the mortality, morbidity, and disability suffered by individuals with HIV infections.

Public Financing and Delivery of HIV/AIDS Care examines the current standard of care for HIV patients and assesses the extent the system currently used for financing and delivering care allows individuals with HIV to actually receive it. The book recommends an expanded federal program for the treatment of individuals with HIV, administered at the state level. This program would provide timely access and consistent benefits with a strong focus on comprehensive and continuous care and access to antiretroviral therapy. It could help improve the quality of life of HIV/AIDS patients, as well as reduce the number of deaths among those infected.

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