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H H S Department of Health and Human Services
Health Resources and Services Administration
HIV/AIDS Programs

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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.

CasesNeed is direct function of the number of people who require care
Federal Insurance ReductionFederal government already pays a portion of HIV/AIDS costs through Medicare and Medicaid
Regional CostsThe cost of medical services varies across jurisdictions
PovertyAreas with high poverty may have inadequate infrastructure for HIV/AIDS care.
Patients themselves may be poorer and more needy.
Death Rate among People with AIDSDirect indicator of higher need
OMB PART performance measure
Prevalence RateAreas 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.

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

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

ItemDescription /SourceYearStatus
CasesLiving Cases of AIDS + HIV from CDC
Living Cases of HIV from Code-based States
Geographic CostsMedical staff wages from BLS
Rent values from HUD
Federal InsuranceEstimates 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
2006Interim values
Death RateDeaths 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– 2005Time period complete
PovertyAverage percentage of population below
100% of FPL, past 5 years
U.S. Census
PrevalenceNumber of cases / total population2006Complete