An increasing share of the Nation's and the Commonwealth's resources are spent each year on health care. Although the quality of American medicine is without equal, particular attention is now being directed toward obtaining the most cost effective care, with recognition that preventive medical treatment, often neglected under illness-based reimbursement models, offers the opportunity for ''better'' care for less eventual cost. The management of patients with asthma is an example of improved long-term outcome with proper preventive treatment. Asthma is a common clinical disorder characterized by reversible obstruction of the 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 million days missed in a recent year, along with an additional 3 million lost 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 the 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-physicians with special training in the management of asthma-patients have a higher degree of function, reduced hospital and emergency room visits, and less time lost from school and work. Such measures include outpatient medication programs, early recognition and treatment of exacerbations, identification and help with avoidance of environmental factors that aggravate or induce disease, and allergen immunotherapy (''allergy shots''). Allergy shots have been shown to be a cost effective way of reducing symptoms along with the need for medication and other direct expense. No one patient care model is right for all Pennsylvanians, or all Americans. Although for the healthy, a generalist primary care 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 her best suited to treat this disease. Any health care package should mandate direct access to an allergist for patients with asthma.
