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Self-perceived unmet health care needs of persons enrolled in hiv care

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Abstract

We examined the prevalence of, and factors associated with unmet health service needs among persons with HIV disease. Data were examined from 1,851 participants in the U.S. AIDS Cost and Service Utilization Study, drawn from 26 medical care providers in 10 cities. Geographic areas with large numbers of AIDS cases, and health care providers within them were chosen as study sites. After completing a screener questionnaire, potential participants at each site were stratifed by illness stage, HIV exposure route, and insurance status; a systematic random sample within those strata were selected for the study. Participants completed a comprehensive survey of HIV-related service use and costs, which also asked them to identify unmet health service needs. Analyses identified the relationship between unmet needs and: stage of illness, type of insurance, source of care, living arrangement, and AIDS prevalence of respondents' geographic region. At least one unmet need was reported by 20% of the sample. Needs for non-institutional services, e.g., dental care, mental health, and medications were more likely to be unmet than need for emergency room and hospital care. While most factors significantly affected the odds of having an unmet need, the greatest effects were found for private insurance and HIV asymptomatic status, both of which decreased the odds of unmet needs by approximately 50%. These findings suggest that insurance coverage for services required during the chronic phase of HIV illness is inadequate and should be augmented.

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Authors and Affiliations

  1. Montefiore Medical Center Department of Epidemiology and Social Medicine, 111 East 210th Street, 10467, Bronx, NY

    Karen A. Bonuck PhD (Instructor)

  2. Department of Epidemiology and Social Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, USA

    Peter S. Arno PhD (Associate Professor)

  3. Department of Health Policy Research, New York University, USA

    Jesse Green PhD (Senior Director of Clinical Evaluation and Outcomes Research)

  4. Division of Cost and Financing, U.S. Agency for Health Care Policy and Research, USA

    John Fleishman PhD (Service Fellow)

  5. Department of Health Services Research and Development, Veterans Affairs Medical Center and Duke University, USA

    Charles L. Bennett MD, PhD (Associate Professor)

  6. Mt. Sinai School of Medicine, City University of New York, USA

    Marianne C. Fahs PhD (Associate Professor and Director of the Division of Health Economics)

  7. Westat, Inc., Rockville, MD

    Carla Maffeo PhD (Vice President)

Authors
  1. Karen A. Bonuck PhD
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  2. Peter S. Arno PhD
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  3. Jesse Green PhD
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  4. John Fleishman PhD
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  5. Charles L. Bennett MD, PhD
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  6. Marianne C. Fahs PhD
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  7. Carla Maffeo PhD
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Additional information

This study was conducted under a subcontract with Westat Inc.

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Bonuck, K.A., Arno, P.S., Green, J. et al. Self-perceived unmet health care needs of persons enrolled in hiv care. J Community Health 21, 183–198 (1996). https://doi.org/10.1007/BF01557998

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