Charges and charge coverage in the treatment of HIV/AIDS patients in a rural southern state.

In Mississippi it was not known where Human Immunodeficiency Virus (HIV) or Acquired Immunodeficiency Disease Syndrome (AIDS) persons receive care, what type of care is available to them, and how care is financed. To ascertain inpatient treatment charges of HIV/AIDS patients, a medical record review was conducted at 10 priority hospitals distributed across Mississippi. One-hundred fifty-six (156) patient records were randomly selected from a population of persons with HIV/AIDS. A total of 3,865 patient days was recorded for all hospitals. Available overall hospital charges per paid day ranged from +401.63 to +1,261.34, with an average charge of +741.65 per day. Average length of stay was 25 days. Average charge per hospitalization per patient totaled +18,541. Concerning source of payment, 44.8% of the patients had private insurance, 29.9% listed Medicaid as their payment source, 7.8% were on Medicare, 1.3% had supplemental insurance, and 16.2% of patients reviewed had no payment source. Based on this review, it is evident that the number of AIDS patients covered by private health insurance will continue to decline and the payment responsibilities will continue to shift to public supported programs. Acquired immunodeficiency syndrome brings attention to the weakness of Mississippi's health care financing system and will continue to force consideration of alternative financing mechanisms.

A model research design to determine whether public programs providing health care for the poor and uninsured are successful.

The Mississippi State Department of Health has developed an empirically-proven two stage methodology of evaluation appropriate for agencies serving individuals that are poor and/or uninsured that utilizes qualitative data drawn from surveys and interviews to formulate a plan of action to collect relevant objective data. Findings are reported as being either supported, non-supported, or fallacious, and are accompanied by recommendations for intervention when appropriate. After comments on these have been assembled and disseminated, the program is required to submit a plan of action addressing all recommendations in the report.

A model research design for comprehensive evaluation of a public home health agency.

The Mississippi State Department of Health developed a five-stage model to perform an evaluation study of its home health services program. A singular element in the process was the deferral of developing the final research design structure until the second stage of evaluation was completed. Primary areas of investigation included identification of verifiable, nonverifiable, and erroneously believed factors affecting program operations; recommendations for changes that could be made in light of research findings to improve program operations both to deliver services and to maximize program earnings; and elements affecting program performance held in common with other home health programs in Mississippi and in other states.

Physicians' views of home health.

The Mississippi State Department of Health surveyed 1412 physicians, response rate being 51.1%. Most had practiced in Mississippi over 10 years. Over 93% were aware of home health in their area. Open-ended responses revealed: (a) A need for better communication and on-going public information/relations concerning referral and available services, (b) Physicians' wish to manage their cases, (c) Complaints about burdensome paperwork and lack of compensation for time/liability, (d) Declines in some areas due to the number of competing agencies, and (e) The suggestion that nurses be assigned to specific physicians, clinics, and hospitals for referral generation.