TY - JOUR
T1 - BRIEF REPORT:Hospitalization Rates among Persons with HIV Who Gained Medicaid or Private Insurance after the Affordable Care Act in 2014
AU - Chow, Jeremy Y.
AU - Nijhawan, Ank E.
AU - Mathews, W. Christopher
AU - Raifman, Julia
AU - Fleming, Julia
AU - Gebo, Kelly A.
AU - Moore, Richard D.
AU - Berry, Stephen A.
N1 - Funding Information:
Supported by the Agency for Healthcare Research and Quality (contract HHSA290201100007C), the Health Resources and Services Administration (contract HHSH250201200008C), the National Institutes of Health (U01 DA036935, P30 AI094189, U01 AI069918, UL1TR000427, K01 MH116817, T32 AI007291-27, R34 DA 045592, and R34 MH 122332), and the Clinical Investigation Core of the UC San Diego Center for AIDS Research (AI036214). J.Y.-S.C., and A.E.N. receive research support from Gilead for an investigator-initiated study unrelated to this article.
Funding Information:
Supported by the Agency for Healthcare Research and Quality (contract HHSA290201100007C), the Health Resources and Services Administration (contract HHSH250201200008C), the National Institutes of Health (U01 DA036935, P30 AI094189, U01 AI069918, UL1TR000427, K01 MH116817, T32 AI007291-27, R34 DA 045592, and R34 MH 122332), and the Clinical Investigation Core of the UC San Diego Center for AIDS Research (AI036214). J.Y.-S.C., and A.E.N. receive research support from Gilead for an investigator-initiated study unrelated to this article. HIVRN Details: Participating Sites: Alameda County Medical Center, Oakland, CA (Howard Edelstein); Children’s Hospital of Philadelphia, Philadelphia, PA (Richard Rutstein): Drexel University, Philadelphia, PA (Amy Baranoski and Sara Allen): Fenway Health, Boston, MA (Stephen Boswell and Kenneth Mayer): Johns Hopkins University, Baltimore, MD (Kelly Gebo, Richard Moore, and Allison Agwu): Montefiore Medical Group, Bronx, NY (Robert Beil): Montefiore Medical Center, Bronx, NY (Uriel Felsen): Mount Sinai St. Luke’s and Mount Sinai West, New York, NY (Judith Aberg and Antonio Urbina): Oregon Health and Science University, Portland, OR (P. Todd Korthuis): Parkland Health and Hospital System, Dallas, TX (Ank Nijhawan and Muhammad Akbar): St. Jude’s Children’s Research Hospital and University of Tennessee, Memphis, TN (Aditya Gaur): Tampa General Health Care, Tampa, FL (Charurut Somboonwit): Trillium Health, Rochester, NY (William Valenti): University of California, San Diego, CA (W. Christopher Mathews): University of Wisconsin-Madison, Madison, WI (Ryan Westergaard). Sponsoring Agencies; Agency for Healthcare Research and Quality, Rockville, MD (Fred Hellinger and John Fleishman): Health Resources and Services Administration, Rockville, MD (Robert Mills and Faye Malitz). Data Coordinating Center: Johns Hopkins University (Richard Moore, Jeanne Keruly, Kelly Gebo, Cindy Voss, Charles Collins, and Rebeca Diaz-Reyes). Disclaimer: the views expressed in this study are those of the authors. No official endorsement by DHHS, the National Institutes of Health, or the Agency for Healthcare Research and Quality is intended or should be inferred.
Publisher Copyright:
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2021/6/1
Y1 - 2021/6/1
N2 - Background: It is unknown whether gaining inpatient health care coverage had an effect on hospitalization rates among persons with HIV (PWH) after implementation of the Affordable Care Act in 2014. Methods: Hospitalization data from 2015 were obtained for 1634 adults receiving longitudinal HIV care at 3 US HIV clinics within the HIV Research Network. All patients were engaged in care and previously uninsured and supported by the Ryan White HIV/AIDS Program in 2013. We evaluated whether PWH who transitioned to either Medicaid or private insurance in 2014 tended to have a change in hospitalization rate compared with PWH who remained uncovered and Ryan White HIV/AIDS Program supported. Analyses were performed by negative binomial regression with robust standard errors, adjusting for gender, race/ethnicity, age, HIV risk factor, CD4 count, viral load, clinic site, and 2013 hospitalization rate. Results: Among PWH without inpatient health care coverage in 2013, transitioning to Medicaid [adjusted incidence rate ratio 1.26, (0.71, 2.23)] or to private insurance [0.48 (0.18, 1.28)] in 2014 was not associated with 2015 hospitalization rates, after accounting for demographics, HIV characteristics, and prior hospitalization rates. The factors significantly associated with higher hospitalization rates include age 55–64, CD4,200 cells/mL, viral load .400 copies/mL, and 2013 hospitalization rate. Conclusions: Acquiring inpatient coverage was not associated with a change in hospitalization rates. These results provide some evidence to allay the concern that acquiring inpatient coverage would lead to increased inpatient utilization.
AB - Background: It is unknown whether gaining inpatient health care coverage had an effect on hospitalization rates among persons with HIV (PWH) after implementation of the Affordable Care Act in 2014. Methods: Hospitalization data from 2015 were obtained for 1634 adults receiving longitudinal HIV care at 3 US HIV clinics within the HIV Research Network. All patients were engaged in care and previously uninsured and supported by the Ryan White HIV/AIDS Program in 2013. We evaluated whether PWH who transitioned to either Medicaid or private insurance in 2014 tended to have a change in hospitalization rate compared with PWH who remained uncovered and Ryan White HIV/AIDS Program supported. Analyses were performed by negative binomial regression with robust standard errors, adjusting for gender, race/ethnicity, age, HIV risk factor, CD4 count, viral load, clinic site, and 2013 hospitalization rate. Results: Among PWH without inpatient health care coverage in 2013, transitioning to Medicaid [adjusted incidence rate ratio 1.26, (0.71, 2.23)] or to private insurance [0.48 (0.18, 1.28)] in 2014 was not associated with 2015 hospitalization rates, after accounting for demographics, HIV characteristics, and prior hospitalization rates. The factors significantly associated with higher hospitalization rates include age 55–64, CD4,200 cells/mL, viral load .400 copies/mL, and 2013 hospitalization rate. Conclusions: Acquiring inpatient coverage was not associated with a change in hospitalization rates. These results provide some evidence to allay the concern that acquiring inpatient coverage would lead to increased inpatient utilization.
KW - Affordable Care Act
KW - HIV
KW - hospitalizations
UR - http://www.scopus.com/inward/record.url?scp=85106666896&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85106666896&partnerID=8YFLogxK
U2 - 10.1097/QAI.0000000000002645
DO - 10.1097/QAI.0000000000002645
M3 - Article
C2 - 33587511
AN - SCOPUS:85106666896
SN - 1525-4135
VL - 87
SP - 776
EP - 780
JO - Journal of Acquired Immune Deficiency Syndromes
JF - Journal of Acquired Immune Deficiency Syndromes
IS - 2
ER -