Asthma is Extremely Costly

7/28/2019 Asthma is Extremely Costly

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Asthma is extremely costly, adding nearly 50 cents to every health care dollar

spent on children with the condition. In 2006, the United States spent eight billion

dollars alone on treating childhood asthma. Also, asthma was associated with

13.6 percent of all pediatric hospitalizations and children with asthma who useemergency department care are significantly more likely than children without asthma to

require inpatient admission (65 percent versus 44 percent). There are widespread racialand ethnic disparities regarding access to effective treatment. .In the United States, the burden of asthma falls disproportionately on Black and Hispanic

largely Puerto Ricanpopulations. These groups have high rates of poor asthma

outcomes, including hospitalizations and deaths. This burden has environmental,socioeconomic, and behavioral causes. As much as 40 percent of the risk of asthma in

minority children is attributable to exposure to residential allergens that could be reduced,

if not eliminated. African-American children and Hispanic children, receive about half as

much outpatient care and medication management than White children. Because they aremore likely to be low-income and medically underserved, Hispanic children also

experience the highest hospital emergency department expenditure rate. Asthma is a

chronic condition with acute exacerbation. Therefore, it is imperative to providecontinuous care in order to control symptoms, prevent exacerbation, and reduce chronic

airway inflammation.

Asthma is extremely costly. Asthma adds nearly 50 cents to every health caredollar spent on children compared to children without asthma. In 2006, the nation spent

eight billion dollars alone on treating childhood asthma. Compared with children who do

not have asthma, pharmaceutical expenditures are nearly four times higher for asthmaticchildren, outpatient office-based expenditures are 55 percent higher, and emergency

department care is 40 percent higher. Asthma was associated with 13.6 percent of all

pediatric hospitalizations in 2006, and children with asthma who use emergency

department care are significantly more likely than children without asthma to requireinpatient admission (65 percent v 44 percent). Racial and ethnic disparities in access to

effective treatment are widespread. Despite the need and risk, health care expenditures

are the lowest for the children most at risk. African-American children and Hispanicchildren receive about half as much outpatient care and medication management than

white children. Yet because they are more likely to be low income and medically

underserved, Hispanic children also experience the highest hospital emergencydepartment expenditure rate. Insurance is key, but we may be missing many children.

Current evidence suggests that Puerto Ricans have a higher prevalence than other

ethnic groups, including other Hispanic groups. Island and mainland Puerto Rican

children have the highest rates of asthma and asthma morbidity of any ethnic group in theUnited States. Mainland and island Puerto Rican children have the highest rates of

asthma of any ethnic group and are more likely to die because of their asthma compared

with other children. Presently numerous studies have been implicated in explaining there

higher rates of asthma and morbidity among minority children, yet the factors accountingfor this disparity are not understood. Presently, poor adherence and inadequate overall

asthma management, service utilization, poor quality of life, and even asthma deaths in

children.


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A specific example of how a state/territory level policy is translating into poor

health outcomes is evidenced by a recently published study by Vila et al. This study

established a correlation between under treatment of pediatric asthma with provider

reluctance of prescribing certain long-term medication. A possible reason for undertreatment may be due to the fact that when a patient requires further treatment the

referring or prescribing physicians absorbs the related costs. The costs of the medicationbeing prescribed are deducted from the capitated amount already given by the PuertoRican Public Health Plan to physicians. This study compared children enrolled in the

publicly managed program versus Puerto Rican children enrolled in the islands privately

managed care programs. This finding has also been substantiated from survey dataprovided by physicians, regarding drug policy provider responses to drug payment policy

in the United States. The data suggests that providers are more likely to prescribe

medications when it does not implicate a financial risk for that prescribing physician.

Literature indicates that there is discrepancy in healthcare reimbursement between

public and private payers in Puerto Rico. The literature has often led researchers to

believe that this frequency of long-term control medication to low-income children withpublic insurance is lower compared to ones on private because the insurance follows the

patient. Therefore, this may be the reason why there is observed health disparity in the

use of asthma control medications as measured by emergency department use and

hospitalization.When payment policies between the private and public health care sectors differ they

could possibly explain differences in medication dispensing and health care utilization

among children with asthma enrolled in the Puerto Rican Public Health Plan as comparedto children enrolled in private insurance plans. Some reason may be due to reluctance

physicians take on patients carrying the public health plan due to knowing the lower

reimbursement schedule went which is then a barrier good heath care access.

The current health policy makes it difficult for providers to deliver high qualitycare due to having to enroll many patients into order maintain a minimum net income.

Specifically, this policy needs to be revised so that primary care providers do not feel

hesitant to prescribe long-term medications to patients with persistent asthma, or to referpatients who require subspecialty care to specialists. Government of Puerto Rico along

with Department of Health needs to focus on strategies to share costs within the territory,

or revisit the low capitation rates.

A specific example of how a state/territory level policy is translating into poor

health outcomes is evidenced by a recently published study by Vila et al. This study

established a correlation between under treatment of pediatric asthma with providerreluctance of prescribing certain long-term medication. A possible reason for under

treatment may be due to the fact that when a patient requires further treatment the

referring or prescribing physicians absorbs the related costs. The costs of the medication

being prescribed are deducted from the capitated amount already given by the PuertoRican Public Health Plan to physicians. This study compared children enrolled in the

publicly managed program versus Puerto Rican children enrolled in the islands privately

managed care programs. This finding has also been substantiated from survey dataprovided by physicians, regarding drug policy provider responses to drug payment policy


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in the United States. The data suggests that providers are more likely to prescribe

medications when it does not implicate a financial risk for that prescribing physician.

Literature indicates that there is discrepancy in healthcare reimbursement betweenpublic and private payers in Puerto Rico. The literature has often led researchers to

believe that this frequency of long-term control medication to low-income children withpublic insurance is lower compared to ones on private because the insurance follows thepatient. Therefore, this may be the reason why there is observed health disparity in the

use of asthma control medications as measured by emergency department use and

hospitalization.When payment policies between the private and public health care sectors differ they

could possibly explain differences in medication dispensing and health care utilization

among children with asthma enrolled in the Puerto Rican Public Health Plan as compared

to children enrolled in private insurance plans. Some reason may be due to reluctancephysicians take on patients carrying the public health plan due to knowing the lower

reimbursement schedule went which is then a barrier good heath care access.

The current health policy makes it difficult for providers to deliver high qualitycare due to having to enroll many patients into order maintain a minimum net income.

Specifically, this policy needs to be revised so that primary care providers do not feel

hesitant to prescribe long-term medications to patients with persistent asthma, or to refer

patients who require subspecialty care to specialists. Government of Puerto Rico alongwith Department of Health needs to focus on strategies to share costs within the territory,

or revisit the low capitation rates.

Emphasis on Provider training is also essential if more children are to be properlymedicated. Research on physician education initiatives show benefits when measuring

follow-up care, patient education, these good practices were implemented due to trainings

provided to physicians. Provider groups who have received training implement changes

in their practices would result in improved disease control for their patients. With abetter health care reimbursement system health care providers could be more aggressive

in ensuring that Puerto Rican children receive appropriate asthma treatment, follow-up

care, and education about asthma triggers and prevention strategies. Underuse ofpreventive anti-inflammatory medications was reported in studies of mostly Puerto Rican

populations. Physicians need to be compensated for their time in order to provide good

continuous care.

f. Need for Change in the Puerto Rican Public Health Plan Policy

The need for leadership will call for a revision of the reforma form ofhealthcare in Puerto Rico. In 1995, Puerto Rico underwent a change in its health policy,

transforming the delivery health care system into a managed care system, which is

equivalent to Medicaid Program on the mainland. This model has increased access to

care by providing a wider net of providers to the medically indigent. But because it hasin place a capitated system of payment, any medications and specialists come out of

primary care providers capitation, the system discourages referral to specialists and the

prescription of costly medications. Primary care physicians therefore are incentivized to


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refer families to emergency departments, which may be contributing to the increased

visits to emergency departments by island Puerto Ricans.

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Asthma is Extremely Costly