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Severity of Need (SON) Index - Draft of SON Index - Explanation of Index Components

Rationale. Each item in the SON Index has a clear reason for being there. Below is an explanation of the rationale for each component.

Component	Rationale
Cases	Need is direct function of the number of people who require care
Federal Insurance Reduction	Federal government already pays a portion of HIV/AIDS costs through Medicare and Medicaid
Regional Costs	The cost of medical services varies across jurisdictions
Poverty	Areas with high poverty may have inadequate infrastructure for HIV/AIDS care. Patients themselves may be poorer and more needy.
Death Rate among People with AIDS	Direct indicator of higher need OMB PART performance measure
Prevalence Rate	Areas with high prevalence rate shoulder a disproportionate burden per uninfected person

Measurement Proxies. Each component in the SON Index is a reflection of a need. The chart below explains the need factor(s) measured by each component. For example, the straightforward component, cases, is a reflection of the number of living HIV and AIDS cases. Poverty, in contrast, is a reflection of multiple needs—from lack of health insurance to poor access to care.

Component	Need Factors Captured
Cases	Reported living HIV and AIDS cases
Federal Insurance Reduction	Medicare/Medicaid enrollment Medicare/Medicaid benefit adequacy Federal share of total Medicare/Medicaid payments Proportion of Ryan White funds devoted to medical services
Regional Costs	Differences in medical labor costs Differences in regional rent costs
Poverty	Lack of insurance Poor access to medical services Racial and ethnic disparities Higher than average substance abuse rates
Death Rate among People with AIDS	Lack of access to timely medical care Patients with longer durations of infection Resistance to antiviral therapies Untreated substance abuse
Prevalence Rate	Burden per person of area population

Data Sources. Below is a description of the data source used to assess each component.

Item	Description /Source	Year	Status
Cases	Living Cases of AIDS + HIV from CDC Living Cases of HIV from Code-based States	2005	Complete
Geographic Costs	Medical staff wages from BLS Rent values from HUD	2006	Complete
Federal Insurance	Estimates of the number of people with SSI, SSDI, or both as a result of an HIV/AIDS diagnosis Information on Medicaid, Medically Needy eligibility Information on special Medicaid enrollment programs 2006 Interim Provided by SSA	2006	Interim values
Death Rate	Deaths over a 5-year period divided by the total life years lived by people with AIDS only in that same period Provided by CDC	2001– 2005	Time period complete
Poverty	Average percentage of population below 100% of FPL, past 5 years U.S. Census	2006	Complete
Prevalence	Number of cases / total population	2006	Complete

Severity of Need (SON) Index