title: Relationship between health insurance and medical care for patients hospitalized with human immunodeficiency virus-related Pneumocystis carinii pneumonia, 1995-1997: Medicaid, bronchoscopy, and survival.
abstract: In the late 1980s, Medicaid-insured human immunodeficiency virus (HIV)-infected patients with Pneumocystis carinii pneumonia (PCP) were 40% less likely to undergo diagnostic bronchoscopy and 75% more likely to die than were privately insured patients, whereas rates of use of other, less resource-intensive aspects of PCP care were similar. We reviewed 1395 medical records at 59 hospitals in 6 cities for the period 1995-1997 to examine the impact of insurance status on PCP-related care. Medicaid patients were only one-half as likely to undergo diagnostic bronchoscopy as were privately insured patients, yet we found no evidence that mortality was greater among patients who received empirical treatment. The bronchoscopy rates were primarily related to patients' personal insurance status. A weaker hospital-level effect was seen that was related to hospitals' Medicaid/private insurance case mix ratios. The situation has evolved from one in which Medicaid coverage was associated with underuse of bronchoscopy and poorer survival among empirically treated persons with HIV-related PCP to one in which empirical therapy is effective in treating this disease and expensive diagnostic procedures may be overused for privately insured patients.
authors: Midwest Center for Health Services and Policy Research, Hines VA Hospital, Hines, IL 60141, USA. parada@research.hines.med.va.gov
authors: Jorge P
authors: JP
authors: Parada
authors: Maria
authors: M
authors: Deloria-Knoll
authors: Joan S
authors: JS
authors: Chmiel
authors: Ahsan M
authors: AM
authors: Arozullah
authors: Laura
authors: L
authors: Phan
authors: Shirin N
authors: SN
authors: Ali
authors: Matthew B
authors: MB
authors: Goetz
authors: Robert A
authors: RA
authors: Weinstein
authors: Rafael
authors: R
authors: Campo
authors: Jeffrey
authors: J
authors: Jacobson
authors: Jack
authors: J
authors: Dehovitz
authors: Daniel
authors: D
authors: Berland
authors: Charles L
authors: CL
authors: Bennett
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000401:mortality / Q000628:therapy; D000368:Aged; D001999:Bronchoscopy; D003695:Delivery of Health Care; D005260:Female; D015658:HIV Infections / Q000401:mortality / Q000628:therapy; D006760:Hospitalization; D006801:Humans; D007348:Insurance, Health; D008297:Male; D008484:Medicaid; D008875:Middle Aged; D011020:Pneumonia, Pneumocystis / Q000401:mortality* / Q000628:therapy; D011787:Quality of Health Care; D015996:Survival Rate