Pearson William S, Goates Scott A, Harrykissoon Samantha D, Miller Scott A
Office of the Associate Director for Policy, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Mailstop E-02, Atlanta, GA 30329. E-mail:
Centers for Disease Control and Prevention, Atlanta, Georgia.
Prev Chronic Dis. 2014 Jun 26;11:E108. doi: 10.5888/pcd11.140139.
The prevalence of childhood asthma in the United States increased from 8.7% in 2001 to 9.5% in 2011. This increased prevalence adds to the costs incurred by state Medicaid programs. We provide state-based cost estimates of pediatric asthma emergency department (ED) visits and highlight an opportunity for states to reduce these costs through a recently changed Centers for Medicare and Medicaid Services (CMS) regulation.
We used a cross-sectional design across multiple data sets to produce state-based cost estimates for asthma-related ED visits among children younger than 18, where Medicaid/CHIP (Children's Health Insurance Program) was the primary payer.
There were approximately 629,000 ED visits for pediatric asthma for Medicaid/CHIP enrollees, which cost $272 million in 2010. The average cost per visit was $433. Costs ranged from $282,000 in Alaska to more than $25 million in California.
Costs to states for pediatric asthma ED visits vary widely. Effective January 1, 2014, the CMS rule expanded which type of providers can be reimbursed for providing preventive services to Medicaid/CHIP beneficiaries. This rule change, in combination with existing flexibility for states to define practice setting, allows state Medicaid programs to reimburse for asthma interventions that use nontraditional providers (such as community health workers or certified asthma educators) in a nonclinical setting, as long as the service was initially recommended by a physician or other licensed practitioner. The rule change may help states reduce Medicaid costs of asthma treatment and the severity of pediatric asthma.
美国儿童哮喘的患病率从2001年的8.7%上升至2011年的9.5%。患病率的上升增加了州医疗补助计划的成本。我们提供了基于州的儿童哮喘急诊就诊成本估算，并强调了各州通过医疗保险和医疗补助服务中心（CMS）最近的一项法规变更来降低这些成本的机会。
我们采用跨多个数据集的横断面设计，以得出18岁以下儿童哮喘相关急诊就诊的基于州的成本估算，其中医疗补助/儿童健康保险计划（CHIP）是主要支付方。
医疗补助/CHIP参保儿童因哮喘急诊就诊约62.9万次，2010年花费2.72亿美元。每次就诊的平均成本为433美元。成本从阿拉斯加的28.2万美元到加利福尼亚的超过2500万美元不等。
各州因儿童哮喘急诊就诊的成本差异很大。自2014年1月1日起，CMS规则扩大了可为向医疗补助/CHIP受益人提供预防服务而获得报销的提供者类型。这一规则变更，结合各州在定义执业环境方面现有的灵活性，允许州医疗补助计划为在非临床环境中使用非传统提供者（如社区卫生工作者或认证哮喘教育者）的哮喘干预措施报销费用，只要该服务最初是由医生或其他持牌从业者推荐的。这一规则变更可能有助于各州降低哮喘治疗方面的医疗补助成本以及儿童哮喘的严重程度。
