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Estimated Cost Impacts of Law to Expand Coverage for Self-Management Education to Children with Asthma in California (Journal of Asthma)

June 1, 2010

CHIS Journal Article

Authors: Gabrielle Lessard, Nadereh Pourat, PhD, Robert G. Cosway, Gerald F. Kominski, PhD

In this journal article, Center researchers Meng, Pourat and Kominksi and their co-author examine the impacts on coverage, utilization, and costs of a California bill that requires health maintenance organizations (HMOs) to expand coverage for pediatric asthma self-management educational services.

The study population includes 503,000 children ages 1-17 years with symptomatic asthma and 134,000 children with uncontrolled asthma insured by California HMOs.

Among the findings: all children enrolled in HMOs in California are covered for clinic-based individual asthma self-management education, though alternative methods, such as group health education classes, and home- or school-based education services are less frequently or not covered at all by HMOs. The authors found the cost estimate for expansion of clinic-based education services to children with symptomatic asthma was approximately $5 million; and expansion of clinic and community-based education services to children with uncontrolled asthma was approximately $1 million annually if utilization increased by 10%.

The findings suggest that expansion of coverage for pediatric asthma self-management education is not very costly, especially for children with uncontrolled asthma, given the potential improvements in asthma outcomes. Further evaluation of feasibility for implementation of community-based education is needed

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