Variations in the Care of HIV-Infected Adults in the United States

Abstract

The US health care system is going through many changes that raise concerns about adequacy of care, including new constraints on public programs¹ and changes in the insurance options available to the privately insured.^2-4 Ascertaining the impact of the emerging organization of services on those most likely to benefit from care is important but difficult. Neither national surveys of households or medical providers nor most studies of specific diseases provide sufficient information. The former studies do not include enough patients with specific conditions of interest to analyze issues of particular concern in the care of those conditions and do not collect enough disease-specific information.⁵ The latter studies usually cannot be broadly generalized, either because they are local or use some form of purposive sampling to assemble a nonrepresentative cohort. Consequently, evidence of disparities in care at 1 or a few institutions may challenge assumptions about adequacy of care to certain sectors of the population, but nationally representative data are needed to determine if broader attention is merited.