As AIDS deaths drop, cash crunch grows

Associated Press Published:

``The bad news is more medical providers are being caught in a revenue crunch,''

with no money for the flood of patients who now need outpatient care, said

Dr. Victoria Sharp of St. Luke's-Roosevelt Hospital in New York.

Worse, says the advocacy group AIDS Action: More and more poor people simply

cannot afford the expensive drugs that promise to prolong their lives. The

drug combinations, which include the powerful protease inhibitors, cost

$15,000 per person every year.

``AIDS is not over. If we act like it is, it may never be,'' said AIDS Action's

Daniel Zingale.

The government announced Monday that deaths from AIDS dropped 19 percent

during the first nine months of 1996, due partly to a slowing of HIV infections

in the late 1980s among white homosexual men _ but also due to better therapy.

Deaths among all men dropped 22 percent, but among women dropped just 7

percent, the Centers for Disease Control and Prevention reported. Deaths

among black Americans dropped 10 percent and Hispanics 16 percent, while

there was a 28 percent decline among whites overall.

``People of color do not have the same access to quality health care,''

Dr. Helene Gayle, CDC's chief of sexually transmitted diseases, said in

explaining the racial discrepancies.

While deaths from AIDS are declining, new cases are increasing but more

slowly than a few years ago. In 1995, about 62,200 people were diagnosed,

an increase of less than 2 percent over the 61,200 new cases in 1994. The

growth rate from 1993 to 1994 was 5 percent.

Congress this week will debate whether to increase the $167 million AIDS

drug assistance program, which buys medicines for poor AIDS patients who

don't qualify for Medicaid. The demand for expensive protease inhibitors

has left the program so cash-strapped that 23 states have had to cut patients

or restrict their access to the drugs.

But the financial problem is broader, said Sharp. Hospitals get far less

reimbursement from either public or private insurance for outpatient care

than for admitting the seriously ill _ so outpatient AIDS clinics are in

trouble, she told a meeting of AIDS experts Monday.

Take St. Vincent's Hospital in New York. Hospital admissions of seriously

ill AIDS patients dropped from 110 a month in 1994 to 50 a month last year,

while the hospital doubled the people treated as outpatients to 2,000 a

month, Sharp said.

That saved insurers $2 million on hospital admissions, Sharp said. Yet even

as outpatient services doubled, insurance payments for those services rose

from just $110,000 a month in 1994 to $182,000 a month in 1996, she said.

And individual patients are feeling the crunch, too. AIDS activist Winnie

Fairchild of Washington said a doctor recently tried to stop her prescription

for protease inhibitor.

The doctor ``said it was not his policy'' to provide expensive drugs to

Medicaid patients, Fairchild said Monday. ``It's not my policy to die, either.''

Denise Stokes of Atlanta described how she went to that city's public hospital

for the poor with a 104.5-degree fever and covered in a rash, a side effect

from her AIDS medication.

``In that physical condition I was expected to stand in line three hours

for medicine'' before she collapsed, said Stokes, an adviser to the Clinton

administration on AIDS issues. ``I made it to the curb, and I laid there

in my own urine while ... (ambulance workers) stepped over me and laughed.''

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