More Non-Hospital Care Urged for AIDS Patients

WASHINGTON —  Alternatives to hospital care for the nation’s growing AIDS population are urgently needed and may provide more compassionate treatment and be less expensive to the nation’s health care system, a congressional panel was told Wednesday.

“For the most part, AIDS patients are not getting the care and services they need,” said Drew E. Altman, vice president of the Robert Wood Johnson Foundation of Princeton.

Ambulatory Services

Altman, appearing before the House Energy and Commerce subcommittee on health and the environment, said that the biggest failing is in the area of ambulatory, in-home and out-of-hospital services.

The need for those services is critical, he said, because “the AIDS epidemic is going to continue to worsen, with the burden on our health care system increasing.”

The Centers for Disease Control estimates that the average national cost of hospital and medical care for AIDS patients has been as high as $147,000. By comparison, Altman said, in San Francisco, where a comprehensive community-based program exists, hospital care averages $29,000 a patient.

Need for Hospices Cited

Rep. Henry A. Waxman (D-Los Angeles), who is chairman of the subcommittee, said that out-of-hospital services, including care in hospices, nursing homes and individual homes with family members, are increasingly important and should be encouraged.

“For humanitarian, economic and public health reasons, alternate care makes sense,” Waxman said. “But, however much sense it makes, it is unavailable to many people with AIDS because of limitations in financing systems.”

The situation he added, has underscored that fact that “AIDS has brought out some of the worst and the best of the American health care system.”

Waxman sharply criticized Reagan Administration plans to eliminate $16 million for Public Health Service demonstration programs for out-of-hospital health care services for AIDS patients.

John Kelso, acting administrator of the Health Resources and Services Administration, said the Administration believes that the responsibility for such planning belongs with the states and the private sector and not at the federal level.

Elmer W. Smith, director of eligibility policy at the Health Care Financing Administration, said $50 million in federal Medicaid funds were spent during fiscal 1985 to care for AIDS patients, and he predicted that $100 million would be spent in fiscal 1986.

He said also that an estimated 40% of AIDS patients are being served under Medicaid and that 1% are receiving care under the Medicare program.

Program Waivers

Smith noted that states can implement alternative health care delivery programs under Medicaid through two types of program waivers. He said he does not believe that another type of waiver is necessary for AIDS-related needs, as some have suggested.

According to the Centers for Disease Control in Atlanta, 17,741 cases of AIDS have been reported as of Feb. 24, and 9,294 have died. And, although the rate of new AIDS cases has slowed in recent months, the number of cases is expected to double in the next 12 to 24 months.