HIV Digest	HIV Digest Archive

The 20-year onslaught of AIDS has radically changed the economics of patient care, and its effects are still being felt throughout the health care system.

At the epidemic's outset when patients needed prolonged bed care, some urban hospitals rushed to create special units to treat them. Because many of

the early patients were young, white, homosexual men whose insurance paid for almost every test and medical service, they were money-makers for hospitals.

Then came the mid-90s and sweeping changes in the epidemic. The advent of drug cocktails gave many patients their lives back while hospitals found themselves facing the loss of a major revenue source [long in-patient stays by fully-insured patients] but still needing to treat the same patients in outpatient clinics.

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Increasingly, the institutions now see HIV patients who are low-income intravenous drug users with no insurance-- money-losers for hospitals.

"AIDS services have gone from being a profit center to a loss center," said Shedrick J. Boren, director of special immunology services at Mercy Hospital, Coconut Grove, Miami. "The change was wonderful news for patients but very bad news for institutions," said Dr. Victoria Sharp, director of the HIV unit at St. Luke's-Roosevelt Hospital Center, New York.

Editor's Note: from the New York Times