reviews. MMP also includes a minimum data set of core surveillance data from NHSS for all individuals sampled.

Limitations of Nationally Representative Studies

Although nationally representative studies hold promise for providing an overarching picture of health care coverage and utilization among people with HIV in the United States, they are generally not useful for generating comparisons among subgroups where stratification results in subgroups too small for meaningful analysis. For example, nationally representative studies such as MMP may not be sufficiently large to permit state-by-state analysis and comparisons of health care coverage and utilization.16 Yet, monitoring health care coverage and experiences at the state level is important because of state variations in implementation of the ACA (discussed in Chapter 2), Medicaid eligibility and benefits, and health care coverage requirements and available options, as well as state and regional disparities in access to health care by people with HIV. Similarly, it will be important to monitor changes in enrollment and in some cases benefits that are expected to occur in various sources of health coverage as the ACA is implemented.

All studies designed to be nationally representative face the difficulty inherent in including marginalized, hard-to-reach populations (e.g., individuals with mental and substance abuse disorders, those in correctional facilities, the homeless). The funding and labor necessary to ensure that all populations are sufficiently represented can be high. Adequate funding and careful attention to sampling and recruitment methods are necessary to ensure the collection of sufficient data for all subpopulations.

REFERENCES

Agwu, A. L., J. A. Fleishman, P. T. Korthuis, G. K. Siberry, J. M. Ellen, A. H. Gaur, R. Rutstein, and K. A. Gebo. 2011. Disparities in antiretroviral treatment: A comparison of behaviorally-HIV-infected youth and adults in the HIV Research Network. Journal of Acquired Immune Deficiency Syndromes 58(1):100-107.

AHRQ (Agency for Healthcare Research and Quality). 1998. HCSUS Fact Sheet. HIV Cost and Services Utilization Study. http://www.ahrq.gov/data/hcsus.htm (accessed March 26, 2012).

Andersen, R., S. Bozzette, M. Shapiro, P. St Clair, S. Morton, S. Crystal, D. Goldman, N. Wenger, A. Gifford, A. Leibowitz, S. Asch, S. Berry, T. Nakazono, K. Heslin, W. Cunningham, and the HCSUS Consortium. 2000. Access of vulnerable groups to antiretroviral therapy among persons in care for HIV disease in the United States. Health Services Research 35(2):389-416.

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16In addition, MMP data are limited to 17 states.



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