PREVENTION AND COST OF ASTHMA - A MODEL FOR COST-EFFECTIVE HEALTH-CARE - COMMENTARY

An increasing share of the Nation's and the Commonwealth's resources a re spent each year on health care. Although the quality of American me dicine is without equal, particular attention is now being directed to ward obtaining the most cost effective care, with recognition that pre ventive medical treatment, often neglected under illness-based reimbur sement models, offers the opportunity for ''better'' care for less eve ntual cost. The management of patients with asthma is an example of im proved long-term outcome with proper preventive treatment. Asthma is a common clinical disorder characterized by reversible obstruction of t he bronchial airways. More than 15 million Americans have asthma-more than one million of them in Pennsylvania. In the United States, asthma is a leading cause of school absence days, accounting for 10.1 millio n days missed in a recent year, along with an additional 3 million los t work days for persons over 18 years of age. A recent study reported in the highly respected New England Journal of Medicine projected that asthma accounted for over $6.2 billion in expenses in 1990, including $3.6 billion in direct outlays for health care and over $2.5 billion in lost time from work and school. The prevalence is increasing, and t he death rate from asthma has more than doubled since 1978 to nearly 5 ,000 a year in the United States. Recent studies demonstrate that when preventive measures are taken under the direction of allergists-physi cians with special training in the management of asthma-patients have a higher degree of function, reduced hospital and emergency room visit s, and less time lost from school and work. Such measures include outp atient medication programs, early recognition and treatment of exacerb ations, identification and help with avoidance of environmental factor s that aggravate or induce disease, and allergen immunotherapy (''alle rgy shots''). Allergy shots have been shown to be a cost effective way of reducing symptoms along with the need for medication and other dir ect expense. No one patient care model is right for all Pennsylvanians , or all Americans. Although for the healthy, a generalist primary car e provider may be the best route of entry into the health care system, patients with asthma benefit by having early and continued access to a specialist whose knowledge, training, and experience makes him or he r best suited to treat this disease. Any health care package should ma ndate direct access to an allergist for patients with asthma.