This study found that mean inflation adjusted inpatient charges for HIV/AIDS patients in Rhode Island increased significantly from 2000 to 2004, after adjusting for LOS, gender, age, race, and point of entry of hospitalization. This increase in inpatient charges followed a significantly increasing linear trend from 2000–2004. These results indicate that HIV/AIDS charges are increasing at a faster than inflation. The variable LOS helped explain most of the variance in HIV/AIDS inpatient charges. Males had significantly higher inpatient charges than females in both multivariable models. Race was also a significant predictor of inpatient charges in the multivariable model that included LOS. However, this result was likely due to the few observations in the other race category. Some admissions in the other race category had higher than expected inpatient charges most likely enabling this finding to occur.
Our findings are in contrast to the findings of studies conducted in the late 1990's, when HAART treatment led to a decrease in inpatient HIV/AIDS charges [2
]. Despite the consistent increase in inpatient charges from 2000–2004, LOS was only significantly higher in 2004 compared to 2001. This suggests that there are other factors that are influencing the increase in HIV/AIDS inpatient charges.
In addition to calendar year and LOS, race, and gender influenced inpatient HIV/AIDS charges. Contrary to other studies, we found that blacks and Asians had significantly lower inpatient charges than whites[8
]. Also, contrary to Gebo et al. this study did not find that females had significantly higher inpatient charges than men[8
This study, like most studies, has limitations. The data we examined cannot account for multiple admissions. It is likely that there were multiple admissions by a single patient. Secondly, Rhode Island Hospital Discharge Data does not contain information on other key factors that are known to influence HIV/AIDS charges. For example, we are unable to determine the proportion of the HIV/AIDS charges that were attributable to medications, co-morbidities, physician charges, and other factors that may influence charges. We were unable to determine how inpatient charges differed by insurance status. This variable was excluded from the analyses based on the fact that more than 25% of the sample had missing insurance information. Another potential limitation is that a proportion of the uninsured HIV/AIDS admissions that were admitted may have decided to not receive hospital care due to lack of finances and thus they would not have the normal LOS and inpatient charges as others. Also, we are unable to attribute what percentage of these inpatient charges were due to other conditions that patients may have been treated for in addition to HIV/AIDS. Lastly, our results are not generalizable beyond Rhode Island. Based on this lack of generalizability we are unable to make inferences for the entire US based on our results.
Despite these limitations our study has important implications for uninsured, as well as insured HIV/AIDS patients whose health care plan does not cover HIV/AIDS treatment adequately. As stated earlier a large portion of HIV/AIDS patients in the US are uninsured. Many of these individuals are of low SES and cannot afford to purchase an adequate health care plan. The increase in HIV/AIDS inpatient charges makes it more difficult for many of these individuals to pay for their treatment, resulting in lack of treatment options which can negatively impact morbidity and mortality rates.