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Background/Objective. Asthma is increasingly being recognized as an important public health concern for children in the United States. Effective management of childhood asthma may require not only improving guideline-based therapeutic interventions, but also addressing social and physical environmental risk factors. The objective of this project was to create a blueprint for improvement of national policy in this area. Design/Methods. A nominal group process with nationally recognized experts and leaders (referred to as "the committee") in childhood asthma. Results. The committee identified 11 policy recommendations (numbered in order below) in 2 broad categories: Improving Health Care Delivery and Financing, and Strengthening the Public Health Infrastructure. Recommendations regarding Improving Health Care Delivery and Financing include the development and implementation of quality-of-care standards in 1) primary care, 2) self-management education, and 3) case-management interventions, and the expansion of insurance coverage and benefit design by 4) extending continuous health insurance coverage for all children, 5) developing model insurance benefits packages for essential childhood asthma services, and 6) educating health care purchasers in how to use them. Recommendations for Strengthening the Public Health Infrastructure include public funding of asthma services that fall outside the insurance system through establishing 7) public health grants to foster asthma-friendly communities and 8) school-based asthma initiatives. 9) Launching a national asthma public education campaign, 10) developing a national asthma surveillance system, and 11) establishing a national agenda for asthma prevention research, with an emphasis on epidemiologic and behavioral sciences, are also recommended. Conclusions. Implementing these recommendations will require coordination of activities at the national, state, and local community level, and within and outside the health care delivery system. With a further commitment of national and local resources, implementation of these recommendations will likely lead to improved child and family asthma outcomes in the United States. Pediatrics 2002;109:919-930; childhood asthma, health care policy, health care services., CURRENT STATUS OF CHILDHOOD ASTHMA IN THE UNITED STATES Childhood asthma is an epidemic with major public health and financial consequences. The number of asthma cases in children under 5 [...]

An overview of Medicaid and proposals to reform it is presented. A Bush proposal called Health Insurance Flexibility and Accountability (HIFA) would provide benefits for people who are currently ineligible by reducing benefits for existing Medicaid beneficiaries.

Insurance companies should not be able to overturn a doctor's decision unless they can point to substantial scientific evidence that the decision is not in the best interests of the patient. Until the 1980s, most insurance companies did not challenge the doctor's decision. However, managed care organizations in particular routinely decide which services they will cover and are therefore deciding which treatment plans are unnecessary. Federal legislation may be required to ensure that insurance companies act in a reasonable manner.

Objectives. This study examined the availability of state funding for comprehensive primary care programs and the need for primary care subsidies for medically underserved communities. Methods. A brief questionnaire was used to ask health agencies in all SO states whether their state funded a program that met our definition of comprehensive primary medical care practice programs. An in-depth written survey instrument was then administered to the states with programs. Results. Almost half of all states provide some funds for the development and/or operation of comprehensive primary medical care practices. Expenditures in most states were found to be relatively modest in comparison with both federal funding and the total level of unmet need for primary care. States that subsidize primary care practices tend to follow the model established under the federal health centers program. Conclusions. The findings suggest the continued viability of the health center model of care, as well as the presence of some state support for such a program. However, in light of limited state resources for the development and operation of comprehensive practices, a continued and significant federal effort is imperative. (Am J Public Health. 1998;88:357-363)