Relationship between Health Insurance and Medical Care for Patients Hospitalized with Human Immunodeficiency Virus-Related Pneumocystis carinii Pneumonia, 1995-1997: Medicaid, Bronchoscopy, and Survival

Jorge P. Parada, Maria Deloria Knoll, Joan S. Chmiel, Ahsan M. Arozullah, Laura Phan, Shirin N. Ali, Matthew B. Goetz, Robert A. Weinstein, Rafael Campo, Jeffrey Jacobson, Jack Dehovitz, Daniel Berland, Charles L. Bennett

Research output: Contribution to journalArticle

Abstract

In the late 1980s, Medicaid-insured human immunodeficiency virus (HIV)-infected patients with Pneumocystis carinii pneumonia (PCP) were 40% less likely to undergo diagnostic bronchoscopy and 75% more likely to die than were privately insured patients, whereas rates of use of other, less resource-intensive aspects of PCP care were similar. We reviewed 1395 medical records at 59 hospitals in 6 cities for the period 1995-1997 to examine the impact of insurance status on PCP-related care. Medicaid patients were only one-half as likely to undergo diagnostic bronchoscopy as were privately insured patients, yet we found no evidence that mortality was greater among patients who received empirical treatment. The bronchoscopy rates were primarily related to patients' personal insurance status. A weaker hospital-level effect was seen that was related to hospitals' Medicaid/private insurance case mix ratios. The situation has evolved from one in which Medicaid coverage was associated with underuse of bronchoscopy and poorer survival among empirically treated persons with HIV-related PCP to one in which empirical therapy is effective in treating this disease and expensive diagnostic procedures may be overused for privately insured patients.

Original languageEnglish (US)
Pages (from-to)1549-1555
Number of pages7
JournalClinical Infectious Diseases
Volume37
Issue number11
DOIs
StatePublished - Dec 1 2003
Externally publishedYes

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Pneumocystis Pneumonia
Medicaid
Bronchoscopy
Health Insurance
Patient Care
HIV
Survival
Insurance Coverage
Private Hospitals
Diagnosis-Related Groups
Insurance
Medical Records
Mortality
Therapeutics

ASJC Scopus subject areas

  • Immunology

Cite this

Relationship between Health Insurance and Medical Care for Patients Hospitalized with Human Immunodeficiency Virus-Related Pneumocystis carinii Pneumonia, 1995-1997 : Medicaid, Bronchoscopy, and Survival. / Parada, Jorge P.; Knoll, Maria Deloria; Chmiel, Joan S.; Arozullah, Ahsan M.; Phan, Laura; Ali, Shirin N.; Goetz, Matthew B.; Weinstein, Robert A.; Campo, Rafael; Jacobson, Jeffrey; Dehovitz, Jack; Berland, Daniel; Bennett, Charles L.

In: Clinical Infectious Diseases, Vol. 37, No. 11, 01.12.2003, p. 1549-1555.

Research output: Contribution to journalArticle

Parada, JP, Knoll, MD, Chmiel, JS, Arozullah, AM, Phan, L, Ali, SN, Goetz, MB, Weinstein, RA, Campo, R, Jacobson, J, Dehovitz, J, Berland, D & Bennett, CL 2003, 'Relationship between Health Insurance and Medical Care for Patients Hospitalized with Human Immunodeficiency Virus-Related Pneumocystis carinii Pneumonia, 1995-1997: Medicaid, Bronchoscopy, and Survival', Clinical Infectious Diseases, vol. 37, no. 11, pp. 1549-1555. https://doi.org/10.1086/379512
Parada, Jorge P. ; Knoll, Maria Deloria ; Chmiel, Joan S. ; Arozullah, Ahsan M. ; Phan, Laura ; Ali, Shirin N. ; Goetz, Matthew B. ; Weinstein, Robert A. ; Campo, Rafael ; Jacobson, Jeffrey ; Dehovitz, Jack ; Berland, Daniel ; Bennett, Charles L. / Relationship between Health Insurance and Medical Care for Patients Hospitalized with Human Immunodeficiency Virus-Related Pneumocystis carinii Pneumonia, 1995-1997 : Medicaid, Bronchoscopy, and Survival. In: Clinical Infectious Diseases. 2003 ; Vol. 37, No. 11. pp. 1549-1555.
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