The effect of insurance coverage on Zimbabwean physicians' treatment decisions for HIV and AIDS patients

Zimbabwean physicians' decisions regarding care were compared for HIV and AIDS patients when they had insurance coverage for antiretroviral drug treatment versus having no coverage. Data were collected using a cross sectional, self-administered questionnaire that was distributed by mail and in person to a national random sample of 800 physicians practicing in Zimbabwe. Two scenarios of coverage versus not were presented to each physician for a patient with either Stage I or Stage IV HIV and AIDS condition. Physicians were compared in terms of the use of diagnostic tests, prescribing of antiretroviral (ARV) drugs and other drugs, and counseling and referral of patients. A usable response rate of 39.5% was obtained.; Insurance coverage was significantly related to diagnostic testing for CD4 cells, viral loading and prescribing ARV drugs in both Stages with more physicians reporting that they would test for patients with coverage. In multivariate logistic regression analysis, the effect of coverage remained robust while the odds of testing for CD4 cells and viral load, and prescribing ARV drugs increased from Stage I to Stage IV HIV disease condition. Coverage had no influence on testing for HIV, telling the patients their HIV status, and on all counseling and referral related activities in both Stages when affirmative responses of "probably would" and "absolutely would" were combined into "would" affirmative response. However, when physicians were compared on "absolutely would" affirmative response only, more physicians reported that they would test covered patients for HIV when compared to patients without coverage in both Stages, suggesting that coverage increases confidence in following through with the testing decision.; A comprehensive coverage policy for ARV drugs would enable appropriate prescribing of ARV therapy and would be important in empowering the physicians' treatment decision making in both early and late Stages of the HIV disease. Future research could address the effect of coverage at the patient level.