One-liner: A set of policy recommendations to promote the development and maintenance of communities in which children with asthma can be swiftly diagnosed, effectively treated, and protected from exposure to harmful environmental factors. An estimated 5 million U.S. children have asthma. Too many of these children are unnecessarily impaired. Much of the money spent on asthma is for high-cost health care services to treat acute periods of illness. Many asthma attacks could be avoided--and much suffering prevented and many medical costs saved--if more children received good-quality, ongoing asthma care and if the 11 policy recommendations presented in this report were implemented in a oordinated fashion. A national call to action, the policy recommendations span public and private interests and compel integration of public health activities across local, state, and federal levels. This report summarizes the findings of an effort funded by the Robert Wood Johnson Foundation as part of the Pediatric Asthma Initiative, whose purpose is to address current gaps in national childhood asthma care. It is the first national initiative that simultaneously addresses treatment, policy, and financing issues for children with asthma at the patient, provider, and institutional levels. The purpose of RAND's effort was to:--identify a range of policy actions in both the public and private sectors that could improve childhood asthma outcomes nationwide--select a subset of policies to create a blueprint for national policy in this area--outline alternatives to implement these policies that build on prior efforts.The effort developed a comprehensive policy framework that maps the identified strategies to one overall policy objective: to promote the development and maintenance of asthma-friendly communities--communities in which children with asthma are swiftly diagnosed, receive appropriate and ongoing treatment, and are not exposed to environmental factors that exacerbate their condition. This report is intended as a working guide for coordinating the activities of both public and private organizations at the federal, state, and local community levels.
Focusing on the subtle interaction between children's well-being and the neighborhoods in which they grow up, the authors consider the age of the community's residents, their incomes, and residential turnover in the neighborhood to draw inferences from the Focused Study of Children and Neighborhoods (FSCN), a survey of three neighborhoods in Los Angeles conducted in 1998. Drawing on the Focused Study of Children and Neighborhoods, a survey of three neighborhoods in Los Angeles conducted in 1998, the authors address the subtle interaction between children's well being and the neighborhoods in which they grow up. The authors consider the age of the community's residents, their incomes, and residential turnover in the neighborhood. The next step in this process will be a large-scale survey of children living in 65 neighborhoods throughout Los Angeles County, called the Los Angeles Family and Neighborhood Survey (L.A.FANS).
New medical technologies are a leading driver of U. S. health care spending. This report identifies promising policy options to change which medical technologies are created, with two related policy goals: (1) Reduce total health care spending with the smallest possible loss of health benefits, and (2) ensure that new medical products that increase spending are accompanied by health benefits that are worth the spending increases.
A focused review of RAND Health research identified small ideas that could save the U.S. health care system $13 to $22 billion per year if successfully implemented. They include changing payment policy for emergency transport and greater use of $4 generic drugs. Small ideas do not require systemic change; thus, they may be both more feasible to operationalize and less likely to encounter stiff political and organizational resistance.
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