METHODS: Claims data for Medicaid HMO children were analyzed for effect of dose counters on ER utilization, hospital admissions and health care costs. Outcomes included hospital admissions/1000, ER visits/1000, health care costs. The potential cost savings from having a dose counter were calculated.
RESULTS: ER visits without dose counter were 149.36 per 1000 and 101.44 per thousand with. Admissions per 1000 without dose counter were 7.91 per 1000 and with 4.36. Admissions were 81.6% higher without dose counter and ER Visits 47.2% higher without dose counter. ER cost per visit without dose counter averaged $792.85 per visit compared to $545.53 with. Cost per hospital admission without was $8778.59 compared to $6854.28 with. ER cost per visit and cost per admission were 45.3% and 28.1% higher. Excess costs associated with absence of a dose counter were $84,670 excess admission costs due to higher cost admissions, $10,882 ER cost for higher cost visits, $216,903 due to a higher number of admissions and $181,667 due to a higher number of ER visits.
CONCLUSIONS: Absence of dose counters in children covered by Medicaid is associated with higher ER visits and hospital admission, higher cost per admission and ER visit and higher overall health care costs due to ER visits and hospital admissions. Absence of a dose counter represents a risk to the life and safety of Medicaid children with asthma as well as wasted health care costs.