By Jennifer Price
Asthma is the single most common chronic condition among children, with one in every seven children diagnosed with the disease that causes attacks of wheezing, shortness of breath, chest tightness and coughing.
The U.S. spends about $8 billion a year treating childhood asthma – more than almost any other childhood condition—in part because more than 1 million children with asthma lack health insurance.
George Washington University School of Public Health and Health Services researchers Sara Rosenbaum and Anne Markus, Ph.D. ’00, spent last year identifying what policy reforms could be made to improve the lives of children with asthma and their families.
“Childhood asthma presents one of the nation’s starkest examples of what is wrong with the health care system. Even as more than 1 million children with asthma lack coverage, the nation is squandering health care dollars on costly treatment while missing key prevention opportunities,” says Ms. Rosenbaum, chair of GW’s Department of Health Policy and the Harold and Jane Hirsh Professor of Health Law and Policy. “To date, the knowledge, programs and infrastructure America has amassed about childhood asthma is like an unassembled puzzle. We have the pieces; it’s time we put them together.”
Their report, “Changing Policy: The Elements for Improving Childhood Asthma Outcomes,” identifies five areas of reform: stable and continuous health insurance; high quality clinical care and case management for all children with asthma regardless of whether they have coverage; asthma trigger reduction in homes and communities; continuous information exchange and monitoring; and coordinating a diverse research agenda.
“For the first time, we have a national plan that turns decades of research and lessons learned from on-the-ground programs into recommendations that will improve outcomes,” says Ms. Rosenbaum. “It’s time to aim higher for the millions of children with asthma and their families.”
The report was funded by the Merck Childhood Asthma Network (MCAN), a nonprofit organization established to address pediatric asthma. MCAN is supported by the Merck Company Foundation, the philanthropic arm of pharmaceutical company Merck & Co. The report was also funded by RCHN Community Health Foundation, a New York based nonprofit foundation whose mission is to support community health centers through strategic investment, outreach, education and health policy research.
The report found that asthma adds nearly 50 cents to every health care dollar spent on children with the disease compared with children without it. Pharmaceutical expenditures are nearly four times higher for asthmatic children. Outpatient office-based expenses are 55 percent higher, and emergency department care is 40 percent higher.
All children-- but especially those with asthma— need stable, continuous and high quality health insurance coverage, the report stresses.
“These kids need a place to go to have their disease properly managed,” said Dr. Markus, an associate professor of health policy in GW’s Department of Health Policy. “If you have an interruption in your coverage or no coverage at all, it may prevent you from going to the doctor or a clinic for a routine checkup. And then you’ll end up in the emergency room when you have an attack.”
About 9 percent, or 1.1.7 million, of all children living with asthma, have no health insurance. But the report estimates that more than half of those children are eligible for Medicaid or the Children’s Health Insurance Program (CHIP). In fact, one in three children living with asthma is poor, and 60 percent have family incomes below twice the federal poverty level.
In order to increase enrollment in Medicaid and CHIP, the report calls for reforms aimed at making it easier for children and families to apply for coverage. For example, families would be able to enroll at their local public school, community health care provider or community center.
Ms. Rosenbaum and Dr. Markus are also encouraging all states to expand Medicaid and CHIP coverage to at least 300 percent of the federal poverty level. Currently only six states—Hawaii, Iowa, Maryland, Vermont, New Hampshire and Wisconsin—and the District of Columbia cover up to 300 percent. Most other states only cover up to 200 percent. Raising the level to 300 percent would cover an additional 1 million children, including 180,000 with asthma.
Other key recommendations include adequately educating children and families on the personalized asthma treatment plans and creating a “safe zones” in homes by using things like humidifiers and protective pillow cases and mattress covers. Evidence has shown that exposure to cigarette smoke, dust mites, mice and cockroach droppings and some pets can trigger asthma attacks.
The report also calls for public health agencies, housing authorities and environmental agencies to reduce the many environmental asthma triggers that lie beyond families’ control such as air pollution. Specific recommendations include restricting emissions, reducing secondhand smoke and ensuring schools are built away from congested roadways.
Ms. Rosenbaum and Dr. Markus presented the report last month on Capitol Hill and briefed the Environmental Protection Agency, the Centers for Medicare and Medicaid Services and the Health Resources Service Administration.
“The report ties together the evidence of childhood asthma with very real steps to make conditions better for children,” says Ms. Rosenbaum. “There is need for comprehensive action.”