Hospital care for persons with AIDS in European-Union countries; a cross-country comparison.
This paper compares AIDS hospital care in several European-Union countries. For this purpose hospital-care utilisation studies on inpatient days and outpatient contacts were analysed in a generic approach controlling for severity stages of AIDS. Lifetime hospital-care needs for AIDS are derived, providing useful information for health-care policy makers. In a next step, lifetime estimates are linked to estimated annual new cases of AIDS, resulting from standardised epidemiological modelling. These results on AIDS impact at the population level are reported including statistical confidence limits. Both lifetime hospital-care needs at the patient level and AIDS impact at the population level are compared between countries and related to characteristics of the national AIDS epidemics and health-care systems. A person with AIDS has a contact--either inpatient day or outpatient visit--with the hospital in 14% (UK) to 24% (France) of the days spent in the AIDS stage. Related to the national AIDS epidemics (epidemiological impact), Italy and Greece have high levels of outpatient contacts per million population. Estimated hospital-bed needs for AIDS in 1995 are up to 2.13% (in Spain) of total national acute-care hospital beds available. Estimated per-capita needs for outpatient visits in 1995 are highest in Italy, corresponding to 108 doctor full-time equivalents. In a case-study for Greece and The Netherlands, differences in hospital-care utilisation patterns were assessed to correspond with differences in their health-care systems (number of hospital beds, doctors and nurses per capita and some qualitative characteristics of medical care in both countries). International comparison of AIDS hospital care is possible using standardised analysis of national hospital-care utilisation data and standardised epidemiological modelling. Estimates of lifetime hospital-care needs are an essential input for cost-effectiveness analyses used to aid health-care policy decision-making.