The impact of AIDS on the health care system in New Jersey

Abstract

The New Jersey State Department of Health will continue to facilitate the creation of health care sites outside of hospitals for people with AIDS. This will relieve some of the burden carried by acute care inner-city institutions and provide more appropriate and humane care. In addition, we are urging hospitals to work with us in performing prospective studies to determine reliable cost estimates. Important questions remain unanswered. How will cost burdens be shared among individuals, private hospitals, HMOs, local/state/federal governments, and insurance companies for their investors? In Chicago, the AIDS Medical Resource Center is doing some innovative work in cost determinations based on patients' needs and negotiating for a prepaid lifetime reimbursement with third party payers. Services are provided via a network of providers who are contractually linked and who share the financial risk should their costs exceed the negotiated fee. Will access to care be equitable? Will we have appropriately trained health care workers for many settings? Will the shortage of nurses affect our ability to provide care? Will insurance companies require HIV testing for new policyholders, thereby resulting in an increase in patients without coverage, or will such testing be prohibited, with insurance companies raising their charges for all so as to cover risk? Some people will then not be able to afford a health insurance policy. These issues deserve consideration from a variety of health professionals, especially in regard to their role and responsibility in addressing them.