Costs and outcomes of AIDS care: comparing a health maintenance organization with fee-for-service systems in the Boston Health Study.
OBJECTIVE
A 4-month observational cohort study was performed to compare the performance of one health maintenance organization (HMO) with two fee-for-service (FFS) systems in Boston, Massachusetts in treating 255 patients with AIDS.


METHODS
Total 4-month costs; cost subcomponents, including inpatient, outpatient, home care, and zidovudine costs; functional status (difficulties with activities of daily living); and satisfaction with care.


RESULTS
Compared with FFS patients, HMO patients were better educated, more often white, less often on Medicaid, and more often reported homosexual or bisexual behaviors as HIV risk factors (all factors, p = .001). Both groups had similar duration of AIDS, baseline hemoglobin levels, and leukocyte counts. Total 4-month costs at the HMO were significantly lower than those in the FFS settings ($4799 U.S. versus $8540 U.S.; p = .013), as were outpatient costs ($1131 U.S. versus $1614 U.S.; p = .001), after adjustment for sociodemographic factors, baseline functioning, main HIV risk factor, and other clinical variables. Adjusted physical functioning (p = .32) and patient satisfaction (p = .82). were similar between systems.


CONCLUSIONS
The HMO had significantly lower total costs without any observable decrement in functional outcomes or patient satisfaction. The largest component of these cost savings came from reduced spending on inpatient care, but the HMO also spent less on outpatient and home care. Better coordination of care at the HMO may have been responsible for these lower costs.
Wilson
I B
IB
Primary Care Outcomes Research Institute and Department of Medicine, New England Medical Center, Boston University School of Medicine, MA 02111, USA. ira.wilson@es.nemc.org
Sullivan
L M
LM
Weissman
J S
JS
D000163:Acquired Immunodeficiency Syndrome / Q000191:economics* / Q000453:epidemiology / Q000628:therapy*; D000328:Adult; D001900:Boston / Q000453:epidemiology; D015331:Cohort Studies; D015986:Confounding Factors, Epidemiologic; D018588:Fee-for-Service Plans / Q000191:economics / Q000592:standards; D005260:Female; D017048:Health Care Costs; D006279:Health Maintenance Organizations / Q000191:economics / Q000592:standards; D006801:Humans; D007348:Insurance, Health / Q000191:economics / Q000592:standards; D007407:Interviews as Topic; D008297:Male; D017060:Patient Satisfaction / Q000191:economics; D011787:Quality of Health Care / Q000191:economics; D044469:Racial Groups; D012959:Socioeconomic Factors; D016896:Treatment Outcome