Address correspondence to Helen Ann Halpin, Ph.D., Professor of Health Policy, and Director Center for Health and Public Policy Studies, University of California, Berkeley, School of Public Health, 140 Warren Hall, Berkeley, CA 94720-7360. Sara B. McMenamin, Ph.D., Assistant Research Professor, and Research Director, is with the Center for Health and Public Policy Studies, University of California Berkeley, School of Public Health, Berkeley, CA. Nadereh Pourat, Ph.D., Adjunct Assistant Professor, is with the UCLA School of Public Health, Department of Health Services, Center for Health Policy Research, Los Angeles, CA. Ed Yelin, Ph.D., Professor, is with the University of California, San Francisco, Institute for Health Policy Studies, San Francisco, CA.
An Analysis of California Assembly Bill 2185: Mandating Coverage of Pediatric Asthma Self-Management Training and Education
Article first published online: 13 MAR 2006
Health Services Research
Volume 41, Issue 3p2, pages 1061–1080, June 2006
How to Cite
Halpin, H. A., McMenamin, S. B., Pourat, N. and Yelin, E. (2006), An Analysis of California Assembly Bill 2185: Mandating Coverage of Pediatric Asthma Self-Management Training and Education. Health Services Research, 41: 1061–1080. doi: 10.1111/j.1475-6773.2006.00520.x
- Issue published online: 13 MAR 2006
- Article first published online: 13 MAR 2006
- Health insurance;
- health policy;
- disease management;
- health education;
- health maintenance organizations
Objective. To summarize for the California Legislature the evidence on the medical effectiveness of pediatric asthma self-management training and education (PASMTE), including the use of peak flow meters, spacers, and nebulizers and the impact that mandated coverage of these services and devices under Assembly Bill (AB) 2185 would have on total health care expenditures, monthly premiums, health services utilization, and the public's health.
Medical Effectiveness Findings. The review of the literature finds that PASMTE is medically effective and has favorable effects on the health of children with symptomatic asthma, as well as reduces asthma-related emergency room visits and hospitalizations. There was inadequate evidence to assess the effectiveness of the three medical devices independently of PASMTE.
Cost and Utilization Findings. One-hundred percent of children in health maintenance organization (HMO) plans in California are already covered for PASMTE, with fewer having coverage for the specific medical devices. However, despite full coverage of PASMTE in HMOs, these services are underutilized. We expect that the enactment of AB 2185 would increase utilization of PASMTE among children who are currently covered by 10 percent as a result of increased awareness of current coverage by all HMOs and increased awareness of the importance of these services. We estimate that this increased utilization by children who are already covered may result in a total statewide premiums increase of $170,000 or 0.006 percent, equal to one to two cents per member per month (PMPM).
Public Health Findings. It is estimated that the public health impact of the mandate, as a result of new utilization of PASMTE by 10 percent of children who are already covered, would reduce the number of school days missed because of asthma per year by 158,000; the number of children reporting restricted activity days by 6,020; the number of emergency department visits by 350; and the number of hospitalizations by 1,105.
Legislative Action. AB 2185 passed the legislature after being amended six times. The bill as it was signed into law did not mandate coverage for PASMTE, as all HMOs in California presently reported covering these services. However, the bill retained the mandate for coverage of the three medical devices, as their coverage was not as universal across health plans.