Insurance Status of HIV-Infected Adults in the Post-Haart Era

Evidence from the United States

Published in: Applied Health Economics and Health Policy, v. 2, no. 2, 2003, p. 85-90

Posted on RAND.org on January 01, 2003

by Dana P. Goldman, Arleen Leibowitz, Geoffrey F. Joyce, John Fleishman, Samuel A. Bozzette, Naihua Duan, Martin F. Shapiro

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In the United States, universal public insurance is only available for the elderly. But unlike most other major diseases, HIV/AIDS predominantly affects the nonelderly. The result is that insurance availability and public programme participation are linked to disease progression in a complicated way. This paper uses data from a unique, nationally representative sample of HIV-infected adults receiving medical care, to describe the relationship between disease progression and insurance coverage in the United States. The authors find that public insurance is the predominant source of coverage for those in care for HIV, and that coverage increases as disease progresses. Those with public coverage have substantial work experience and earnings capacity, but do not work. This suggests that reforms allowing HIV positive (+) patients to maintain public coverage while returning to work could increase employment and earnings significantly. More speculatively, it suggests that the United States system for financing health care is not well-equipped to deal with epidemics that afflict a population in its prime work years.

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