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Insurance coverage, usual source of care, and receipt of clinically indicated care for comorbid conditions among adults living with human immunodeficiency virus. Med Care 2005 Apr;43(4):401-10

Date

03/22/2005

Pubmed ID

15778643

DOI

10.1097/01.mlr.0000156850.86917.f8

Scopus ID

2-s2.0-20244371039 (requires institutional sign-in at Scopus site)   34 Citations

Abstract

BACKGROUND AND OBJECTIVES: Associations of insurance coverage and source of care with use of human immunodeficiency virus (HIV)-related health, mental health, and substance abuse services are examined in a large, diverse, highly active antiretroviral therapy-era cohort.

METHODS: Adults who were infected with HIV (n = 3818) were interviewed in clinics and community agencies in Los Angeles, Milwaukee, New York, and San Francisco regarding drug use behaviors, health status, and health care utilization.

RESULTS: Most participants were insured by Medicaid. During the previous 3 months, 90% of privately insured, 87% of publicly insured, and 78% of uninsured participants had visited any provider. Publicly and privately insured participants were similar in receipt of antiretrovirals, prophylaxis against Pneumocystis carinii pneumonia, substance abuse services, and antidepressants. Uninsured participants were less likely to receive antiretrovirals but were more likely to use substance abuse services. Participants with no usual source of care were less likely to receive PCP prophylaxis.

CONCLUSIONS: A lack of insurance is associated with barriers to care, but the advantage of private over public coverage appears smaller than in previous studies. PCP prophylaxis, substance abuse treatment, and antidepressants remain markedly underutilized. Educational initiatives about these treatments targeting providers and patients are indicated.

Author List

Goldstein RB, Rotheram-Borus MJ, Johnson MO, Weinhardt LS, Remien RH, Lightfoot M, Catz SL, Gore-Felton C, Kirshenbaum S, Morin SF, NIMH Healthy Living Trial Group

Author

Lance S. Weinhardt MS,PhD Associate Dean for Research and Professor of Community and Behavioral Health Promotion in the Joseph. J. Zilber School of Public Health department at University of Wisconsin - Milwaukee




MESH terms used to index this publication - Major topics in bold

AIDS-Related Opportunistic Infections
Adult
Ambulatory Care Facilities
Anti-Retroviral Agents
Antibiotic Prophylaxis
Antidepressive Agents
Antiretroviral Therapy, Highly Active
Depression
Female
HIV Infections
Health Maintenance Organizations
Health Services
Health Services Accessibility
Humans
Insurance Coverage
Insurance, Health
Male
Medicaid
Pneumonia, Pneumocystis
Private Practice
Substance-Related Disorders
United States