Fact, fiction, and fairness: Resource allocation under the Ryan White CARE Act

Health Affairs

Volumn 25, Issue 4, 2006, Pages 1103-1112

  Martin, Erika G ^a   Pollack, Harold A ^b   Paltiel, A D ^c  

^a YALE UNIVERSITY   (United States)

^b The University of Chicago   (United States)

^c YALE UNIVERSITY SCHOOL OF MEDICINE   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; ECONOMICS; ETHNOLOGY; GEOGRAPHY; GOVERNMENT; HEALTH CARE DELIVERY; HEALTH CARE PLANNING; HEALTH CARE QUALITY; HEALTH SERVICE; HUMAN; HUMAN IMMUNODEFICIENCY VIRUS INFECTION; LEGAL ASPECT; POVERTY; PROGRAM DEVELOPMENT; QUESTIONNAIRE; RESOURCE ALLOCATION; SOCIAL JUSTICE; UNITED STATES;

GEOGRAPHY; HEALTH SERVICES ACCESSIBILITY; HIV INFECTIONS; HUMANS; MEDICALLY UNDERSERVED AREA; POVERTY AREAS; PROGRAM DEVELOPMENT; PROGRAM EVALUATION; QUALITY OF HEALTH CARE; QUESTIONNAIRES; RESOURCE ALLOCATION; SOCIAL JUSTICE; UNITED STATES; UNITED STATES HEALTH RESOURCES AND SERVICES ADMINISTRATION; URBAN HEALTH SERVICES;

EID: 33746894531     PISSN: 02782715     EISSN: 02782715     Source Type: Journal    
DOI: 10.1377/hlthaff.25.4.1103     Document Type: Article

References (30)

1. See Health Resources and Services Administration, HIV/AIDS Bureau, "Ryan White CARE Act," http://hab.hrsa.gov/history.htm (accessed 18 April 2006).
2. Ryan White Comprehensive AIDS Resources Emergency Act of 1990, P.L. 101-381 (18 August 1990).
3. U.S. Department of Health and Human Services, "Ryan White Care Act Reauthorization Principles," Fact Sheet, 27 July 2005, http://www.hhs.gov/ news/press/2005pres/ryanwhite.html (accessed 27 October 2005).
4. Centers for Disease Control and Prevention, "AIDS Cases Reported to CDC, July 1989 through June 1999, and Estimates of the Number of Persons Living with AIDS, by State and Metropolitan Area, as of June 30, 1999," HIV/AIDS Surveillance Supplemental Report 6, no. 1 (2000), http://www.cdc.gov/hiv/stats/ hasrsupp61.pdf (accessed 18 April 2006).
5. Institute of Medicine, Measuring What Matters: Allocation, Planning, and Quality Assessment for the Ryan White CARE Act (Washington: National Academies Press, 2004).
6. "Politics and Policy - Ryan White Care Act: Coburn Criticizes Fund Distribution," American Health Line, 24 May 2000.
7. E.M. Duke, "Guarding the Fight against AIDS" (Letter to the Editor), New York Times, 29 August 2005.
8. Sen. Hillary Rodham Clinton, "Senators Clinton, Lautenberg, and Others Fight to Preserve Funding for States with High HIV/AIDS Populations," Press Release, 23 June 2005, http://clinton.senate.gov/news/ statements/details.cfm?id=239909 (accessed 27 October 2005).
9. CDC, "Cases of HIV Infection and AIDS in the United States, 2003," HIV/AIDS Surveillance Report no. 15 (2003), http://www.cdc.gov/hiv/ stats/2003SurveillanceReport.htm (accessed 18 April 2006).
10. Henry J. Kaiser Family Foundation, "Daily HIV/AIDS Report: HHS Proposes Principles for Ryan White CARE Act Reauthorization; Focus Is on Need-based Grant Distribution," 28 July 2005, http://kaisernetwork.org/ daily_reports/rep_index.cfm?DR_ID=31677 (accessed 27 October 2005).
11. DHHS, "Ryan White Care Act Reauthorization."
12. IOM, Measuring What Matters.
13. Duke, "Guarding the Fight against AIDS."
14. "Guarding the Fight against AIDS" (editorial), New York Times, 18 August 2005.
15. Kaiser Family Foundation, "Daily HIV/AIDS Report."
16. For further methodological detail, including graphical presentation of RWCA funding trends, see Technical Appendix at http://content.healthaffairs.org/ cgi/content/full/25/4/1103/DC1.
17. Results from regressions that include emerging community funds are available from the authors but are virtually identical to those reported here. Contact erika.martin@yale.edu.
18. We describe the reasons for this in the Technical Appendix, cited in Note 16.
19. Ibid., regarding the CDC's geographical categorization. Following the IOM report, we used dollars per ELC as our outcome. The accuracy of the ELC measure strongly influences the validity of the analysis; however, we deliberately used this case index to test how well the government adheres to its own defined standards of fairness.
20. Any changes from the 2000 reauthorization and administration change would likely be seen in 2001 or 2002. However, since we used data from even years only,we set 2000 as our change point.
21. See Appendix Exhibit 1 (cited in Note 16) for a state-specific list of the number of ELCs and total Title I and II awards in 1998 and 2004.
22. Graphical depictions of the numbers in Exhibit 2 (smoothed mean curves superimposed on state-specific trajectories) are available as Appendix Exhibits 2 and 3, cited in Note 16.
23. Separate regressions for states with and without Title II funding confirm conclusions from models presented here.
24. Results excluding the District of Columbia are available from the authors; see Note 17.
25. Ibid., for results excluding Florida.
26. Ibid., for results of the political power variable.
27. U.S. Government Accountability Office, Ryan White CARE Act: Factors That Impact HIV and AIDS Funding and Client Coverage, Pub. no. GAO-05-841T (Washington: GAO, 23 June 2005).
28. Clinton, "Senators Clinton, Lautenberg, and Others Fight to Preserve Funding."
29. DHHS, "Federal Financial Participation in State Assistance Expenditures; Federal Matching Shares for Medicaid, the State Children's Health Insurance Program, and Aid to Needy Aged, Blind, or Disabled Persons for October 1, 2005 through September 30, 2006," Federal Register (24 November 2004), http://aspe.hhs.gov/health/fmap06.pdf (accessed 27 October 2005).
30. Richard Zeckhauser, Kennedy School of Government, class lecture, September 2002.