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Pediatric AIDS at Mount Sinai Medical Center 1988-89: a study of costs and social severity
1Department of Community Medicine, Mount Sinai Medical Center, New York, NY 10029, USA.
Insights
Caring for children with pediatric AIDS is costly, with high inpatient and clinic expenses. Social worker support is crucial for managing complex family challenges and improving patient outcomes.
Area of Science:
- Pediatric Medicine
- Public Health
- Health Economics
Background:
- Pediatric AIDS remains a significant challenge, exacerbated by maternal transmission and adverse social determinants of health.
- The medical and social complexities of pediatric AIDS cases often strain family resources and healthcare systems.
- Previous cost analyses may not fully capture the comprehensive care needs of this vulnerable population.
Purpose of the Study:
- To determine the inpatient and clinic care costs for pediatric AIDS patients admitted in 1988-1989.
- To assess the social severity of these pediatric AIDS cases.
- To provide updated cost data and insights into the social factors impacting care.
Main Methods:
- Cost analysis using Blue Shield allowances for clinic services and drug trade publication prices for medications.
- Calculation of per-person-month costs for both inpatient and outpatient care.
- Social severity assessment based on family environment at admission and follow-up.
Main Results:
- Annual inpatient costs averaged $48,000 per person-month at risk.
- Annual clinic care costs averaged $5,500 per person-month, with 38% attributed to medications.
- Costs exceeded those reported in prior studies, with a few intensive cases driving a large proportion of expenses.
- Social severity analysis revealed significant family stressors including chronic illness, substance abuse, and poor housing.
Conclusions:
- The high cost of pediatric AIDS care necessitates efficient resource allocation and targeted interventions.
- Social worker interventions are vital for family support, enhancing treatment compliance, and reducing hospital utilization.
- Addressing the social determinants of health is essential for comprehensive pediatric AIDS management.
Abstract:
Pediatric AIDS is a continuing problem because of maternal transmission. Medical management is often complicated by the loss of one or both parents and adverse home environments. This study explores the cost of inpatient and clinic care of children admitted with AIDS in 1988 or 1989 at Mount Sinai Medical Center in New York City, and also examines the social severity of the cases. Blue Shield allowances were used to price clinic visits and tests, and prices in a drug trade publication were used to determine medication costs. Inpatient costs calculated per person-month at risk amounted to $48,000 per year. Costs per person-month of the clinic care averaged $461 (38% of which was for drugs), annualized to around $5,500. These costs are higher than those shown by previous studies. A few cases requiring intensive inpatient services accounted for a large percentage of costs. The social severity analysis, based on the family environment at first admission and later, revealed that households were often stressed by chronic illnesses, drug abuse, marital problems and poor residential quality. Given the circumstances in which pediatric AIDS develops, the activities of social workers to strengthen families are essential to facilitating compliance, maintaining health and minimizing use of the hospital.
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