[Management of patients with HIV infection: utilization of hospital structures and cost]

This pilot survey covers 2,772 stays of AIDS-related patients in 13 French public hospitals over 3 months (August, September and October 1988). The public sector in France accounts for two thirds of all hospital beds but it is likely to be responsible for the hospitalization of nearly all AIDS-related patients. Of these 2,772 stays, 62% last less than 24 hours: indeed, 22% occur in day-care hospitals and about 40% in conventional hospitals (Fig. 3). These percentages evidence the need for steady expansion of the day-care facilities which were created some years ago. Among the patients experiencing a stay of more than 24 hours, the average length of stay varies from 7.5 days (asymptomatic HIV+ patients) to 15.5 days (confirmed AIDS patients). If all stays are taken into account (Fig. 4), the average length decreases, naturally, to lower levels, 2.8 days (HIV+) and 8.1 days (AIDS). Of course, a patient may have several stays during a single year, plus a number of consultations in the out-patient department. Direct medical expenditures per stay, including only diagnostic and care (excluding accommodation, staff wages and other recurrent expenditures of the hospital) increase from 1,960 French Francs for an asymptomatic HIV+ patient to 4,160 French Francs for a confirmed AIDS patient. Average expenditures per day of stay understandably show a reverse trend, from 715 French Francs for HIV+ to 510 French Francs for AIDS patients. Broad deviation from these averages is observed: for a confirmed AIDS patient stay, the extreme values are 580 FF and 38,000 FF (Table VIII). Such a large variation is partially caused by the state of the illness specific to each individual patient. But its main factor is possibly the lack of standardization in diagnostic and therapeutic procedures, accompanied by unawareness of the cost problem among medical doctors.