The National Public Health and Hospital Institute (NPHHI) conducted six surveys that documented the impact of HIV/AIDS on the nation's hospitals, especially safety net providers, between 1986 and 1997.
The surveys provided the first national profile of hospital services used by AIDS patients. They showed the cost of these services and the financing of them, including regional variances.
- Project data confirmed the substantial cost of treating AIDS patients in the US—in 1985: $380 million (only 75% of it covered by insurance); in 1987: $486 million, with public hospitals shouldering a disproportionate burden of the care and expense.
- Throughout the survey period, the Northeast reported the highest number of AIDS and HIV patients per hospital.
- Since 1989, surveys have shown decreased hospital utilization rates for HIV patients. These more recent surveys also indicate that the federal sector is paying for an increasing portion of the cost of care, and hospitals have reduced their losses per patient.
- In 1985, public hospitals in major metropolitan areas treated, on average, almost twice the number of AIDS patients as private teaching hospitals.
- The 1987 survey revealed that fewer than 5 percent of hospitals treated more than 50 percent of the identified AIDS cases.
- Children with AIDS have longer and more costly hospital stays than other pediatric patients or adults with AIDS, according to the 1987 survey.
- There was a significant decrease in hospital utilization between 1989 and 1993.
Survey findings for 1985, 1988, and 1989 were reported in articles by the principal investigator in The Journal of the American Medical Association (JAMA).
In 1988 and 1989, the principal investigator, Dennis P. Andrulis, Ph.D., presented testimony before the National Commission on the HIV Epidemic, which decided to use the project's figures on the hospital cost-per-day for HIV/AIDS care as the national figure.
In 1991, he was asked by congressional staff to discuss the burden of inpatient care for HIV/AIDS on hospitals and the potential value of setting up a way to spread the responsibility into the community.
The Ryan White Emergency Care Act of 1992 provided a federal mechanism to fund community-based HIV/AIDS care. According to Andrulis, a JAMA article in May 1992 helped lead to the Centers for Disease Control and Prevention's expansion of their definition of AIDS to include HIV-related illnesses.