title: Public funding of HIV/AIDS prevention, treatment, and support in California.
abstract: OBJECTIVE
  To determine the amount of public financing for HIV/AIDS in California and its distribution among treatment, prevention, and support services. To determine the geographical distribution of public financing for HIV/AIDS within California.
  
  
  METHODS
  Data on HIV/AIDS expenditures were compiled across federal and state agencies supporting HIV/AIDS in fiscal year 2008.
  
  
  METHODS
  Federal and state data on programs that finance HIV/AIDS treatment, prevention, and support services, including the Ryan White Program, the Centers for Disease Control and Prevention, and the California General Fund, were compiled. California-specific expenditures for Medicare and Medicaid were calculated from claims data. Other entitlement program spending was estimated from national HIV/AIDS data. Data on AIDS cases by county were obtained from the California State Office of AIDS. Mapping to California counties was accomplished with Arc-GIS software.
  
  
  RESULTS
  Public funders accounted for approximately $1.92 billion in HIV/AIDS services in California in fiscal year 2008. Most (90.4%) supported treatment; prevention accounted for 6.4% and support services for 2.6%. The majority of treatment financing came from 2 Federal health entitlement programs, Medicare (36%), and Medicaid (28%). Counties with the highest case loads had lower expenditures per case, suggesting economies of scale.
  
  
  CONCLUSIONS
  Treatment expenditures overshadow prevention spending. The dominance of entitlement programs in funding for HIV/AIDS treatment challenges policy makers to monitor the extent and quality of HIV/AIDS care in California. A unified health information system for HIV/AIDS that bridged the fragmented health payment system's data silos would benefit policy makers' efforts to monitor the delivery of HIV/AIDS services.
authors.affiliation: Department of Public Policy UCLA School of Public Affairs, Los Angeles, CA 90095-1656, USA. Arleen@ucla.edu
authors.forename: Arleen A
authors.initials: AA
authors.lastname: Leibowitz
authors.forename: Alison C
authors.initials: AC
authors.lastname: Mendes
authors.forename: Katherine
authors.initials: K
authors.lastname: Desmond
mesh_terms: D019380:Anti-HIV Agents / Q000191:economics* / Q000627:therapeutic use*; D002140:California / Q000453:epidemiology; D003695:Delivery of Health Care / Q000191:economics; D005380:Financing, Government / Q000458:organization & administration*; D015658:HIV Infections / Q000188:drug therapy / Q000191:economics* / Q000453:epidemiology / Q000517:prevention & control*; D006296:Health Services / Q000191:economics*; D006297:Health Services Accessibility / Q000191:economics; D006801:Humans
chemical_list: D019380:Anti-HIV Agents