Expanding coverage: reflections on recent efforts.

This paper focuses on the major health care initiatives and proposals that policymakers have enacted or considered since 1980 and describes what we can learn from these efforts to expand coverage. Most proposals have focused on incremental strategies, through expansion of public programs or tax incentives for the purchase of private coverage, although universal proposals have also emerged. Incremental approaches, which seem more politically feasible, still involve complex policy trade-offs. Efforts to improve take-up rates of public and private insurance could greatly expand coverage as well.

Medicaid costs and birth outcomes: the effects of prenatal WIC participation and the use of prenatal care.

This study examines the effects of prenatal WIC participation and the use of prenatal care on Medicaid costs and birth outcomes in five states--Florida, Minnesota, North Carolina, South Carolina, and Texas. The study period is 1987 for Florida, Minnesota, North Carolina, and South Carolina and January-June 1988 for Texas. Prenatal WIC participation was associated with substantial savings in Medicaid costs during the first 60 days after birth, with estimates ranging from $277 in Minnesota to $598 in North Carolina. For every dollar spent on the prenatal WIC program, the associated savings in Medicaid costs during the first 60 days ranged from $1.77 to $3.13 across the five states. Receiving inadequate levels of prenatal care was associated with increases in Medicaid costs ranging from $210 in Florida to $1,184 in Minnesota. Prenatal WIC participation was associated with higher newborn birthweight, while receiving inadequate prenatal care was associated with lower birthweight.

A modeling framework for AIDS/HIV nonacute care services.

This paper describes the conceptual structure underlying the microcomputer-based modeling system developed by Mathematica Policy Research, Inc. The modeling system was developed to assist communities in planning nonacute care services for symptomatic human immunodeficiency virus (HIV)-infected persons. The modeling system is based on the assumptions that (1) the characteristics of the HIV epidemic and the availability of nonacute care service vary across communities and (2) combinations of nonacute care services can be appropriately substituted for one another and for hospital-based nonacute care to meet the varying medical and social needs of symptomatic HIV-infected persons.

Economic consequences for Medicaid of human immunodeficiency virus infection.

Medicaid is currently a major source of financing for health care for those with acquired immunodeficiency syndrome (AIDS) and to a lesser extent, for those with other manifestations of human immunodeficiency virus (HIV) infection. It is likely to become even more important in the future. This article focuses on the structure of Medicaid in the context of the HIV epidemic, covering epidemiological issues, eligibility, service coverage and use, and reimbursement. A simple methodology for estimating HIV-related Medicaid costs under alternative assumptions about the future is also explained.

Psychosocial services for AIDS patients in the general hospital.

Ninety consecutive non-repeating hospital admissions of patients with AIDS were studied. The rates of psychosocial service utilization were quite high for consultation psychiatry (24.4%), social work (42.2%), and home care (discharge planning) nursing (24.4%). The presence of psychiatric co-morbidities and social needs were associated with increased length of stay. In addition, psychiatric co-morbidities were associated with increased charges for pharmacy and laboratory.

AIDS cost modeling in the U.S.: a pragmatic approach.

Sophisticated modeling of the economic impact of AIDS remains a future goal rather than a present reality due to a lack of data. However, policy makers with responsibility for implementing AIDS-related programs have an immediate need for estimates of service utilization and costs. In this paper we describe a microcomputer-based planning model which is structured to reflect the 'epidemic of epidemics' nature of AIDS. In the process of constructing this model, deficiencies in existing data sources have become evident. The second part of the paper describes research issues and priorities for improving data used to estimate the cost of AIDS.