America Living With AIDS

ME RICA Living

with AIDS is $32,000 in 1990
(Hellinger, 1991)." However, because
the proportion of intravenous drug
users in the AIDS patient population
is rising, this estimate may have to be
adjusted upward in the future. Intravenous drug users with HIV disease
tend to incur higher than average
annual costs than gay men with HIV
disease as a result of their generally
poorer state of health and inability to
obtain outpatient and preventive care.
Future cost estimates will also have to
be adjusted to reflect changing treatment modalities, but the direction of
change could be either up or down.
New drugs may be more or less costly,
depending on their cost of manufacture, their effectiveness, and the manner in which they are administered.
Even if more costly, better drugs may
still lead to fewer hospitalizations and
shorter lengths of stay. There may
well be other cost factors to be considered, particularly in rural settings
where the cost of transportation is a
factor and where already tenuous
resources for general health care may
be disastrously affected by the unexpected expense of AIDS care.
Much of the estimated cost of care
for AIDS and for earlier stages of HIV
disease, especially early intervention
* Of course, direct medical care costs are not the
only costs of AIDS. As noted by Yelin and colleagues in 1991: "... the largest component of cost
of human immunodeficiency virus (HIV)-related
illness is due to lost work rather than to direct
expenditures for medical care, reflecting the onset
of this condition among persons in the first half of
their careers...." Other indirect costs of HIV disease include prevention and education programs,
screening of the blood and tissue supply, and training of health care workers.

care, reflects high drug prices. Medications are key to improvements in the
functional status of patients and to the.
prevention of Pneumocystis carinii
pneumonia, a leading cause of hospitalization and death for people with
HIV disease. The average cost of providing early intervention to individuals with HIV disease was recently estimated to be $5,904 per year in 1990
(Arno and Shenson, 1990). This cost
is somewhat lower than in earlier
years, but it still poses a considerable
financial burden to those who have
moderate or low incomes or are uninsured. It may even be a burden for
insured people, as prescription drugs
are not covered by all private insurers,
nor does Medicare cover them. Even
with Medicaid, coverage of drugs is
selective and varies from state to state.
THE CURRENT SYSTEM
The United States provides health care
through a patchwork system centered
on employer-sponsored private health
insurance. This is supplemented, at
least in part, by government entitlement programs, most notably Medicare and Medicaid, covering primarily
the elderly, the disabled, and the poor.
Recent estimates indicate that private
health insurance covers approximately
29 percent of individuals with AIDS,
Medicaid covers approximately 40
percent, Medicare covers 2 percent,
and the remaining 29 percent are
uninsured. Some of the uninsured
individuals may be eligible for direct

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