Estimated cost impacts of law to expand coverage for self-management education to children with asthma in California

Abstract

Background: The California Legislature requires health maintenance organizations (HMOs) to expand coverage for pediatric asthma self-management educational services under two scenarios: education in clinic settings (to include group education) for symptomatic children; education in clinic and community settings (to include home- or school-based education) for children with uncontrolled asthma. Objective. This study aims to determine the impacts of the bill on coverage, utilization, and costs.

Methods: 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. The net effects of the expansion of coverage on costs were estimated after factoring in both the new costs associated with increases in utilization of expanded asthma self-management education as well as the cost savings resulting from reduced asthma-related emergency room visits and hospitalizations.

Results: 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 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%.

Conclusions: Our 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.