By Dr. Larry Chiaramonte
Our News page has an item about a program called the Community Asthma Initiative, run by Boston Children’s Hospital, which provides “worst of the worst” pediatric asthma patients with intensive home management service as well as medical treatment. We wrote briefly about this program in the introduction of our book because Dr. Atul Gawande referred to it in a New Yorker article just before we closed our manuscript. A fuller account of what the program comprises can be found here. Among the extras provided are: vacuum cleaners and dust mite-proof bedding, non-toxic ways to reduce pests, such as garbage cans with tight covers or copper gauze to fill in mouse holes, help with eliminating dust-trapping household clutter, an exterminator if necessary, environmental assessments to detect household mold and moisture, and intercession with city inspectors to lean on landlords to eliminate mold and water leaks.
The payoff in dollars saved is a buck and a half per one per dollar expenditure. As a taxpayer, it sounds good to me. As an asthma specialist, it certainly sounds logical—and eminently repeatable in other high-asthma locales, like the one I work in. Except that this program and others that make sense in terms of finances and social and medical outcomes have the unintended consequence that they cut revenues to providers. “We” save; the hospital loses. Boston Children’s may not actually be threatened with insolvency, as Dr. Gawande asserted, but there’s no question that a regular flow of pediatric asthma emergencies is a staple of hospital cash flow in many institutions.
One of the big struggles in reforming health care is how to reward better outcomes and lower costs. The system we have is riven by incentives so perverse they make the mortgage-backed securities market look like a lemonade stand (and come to think of it, where would the lemonade stand be without sugar and lemons provided by Mom?).
I am old enough to retire. I continue to practice as I do because I want to make people better. For me that’s incentive enough.
Asthma Allergies Children parent's web guide
Asthma Allergies Children | is a website devoted to ideas that are within the guidelines set by accredited medical authorities for treatment of asthma and allergies.
