School Based Health Clinics

School-based health clinics bring care to where it is needed. By placing children in proximity to health care providers, communities can avoid emergency room visit and hospitalizations, keep kids in class, and save money.

School-based health centers (SBHCs) are thought to be one solution to reduce health care disparities by overcoming barriers to access to care.  Such barriers include lack of transportation, lack of providers, lack of insurance coverage and inconvenient appointment times.  This study sought to measure the impact of SBHCs on disparities and their ability to produce a positive net social benefit to the population.

Seven schools with newly implemented SBHCs  in Greater Cincinnati, Ohio, were matched with 6 schools without SBHCs based on urban or rural status, percentage of non-White students, and percentage of students in the free or reduced price school lunch program.

In this cost-benefit analysis, data was collected from student enrollment databases, Ohio Medicaid claim database, the SBHC encounter data, and surveys of parent and SBHC coordinators.  The costs analyzed were health care costs (operational, equipment, and work hours), patient and family costs (travel, co-payments and lost work time), and infrastructure costs (start-up and facility use).  The benefits measured were the students’ health status change, value and/or grants created by SBHCs, resources saved by the SBHCs that were not spent on the above costs, and other unquantifiable benefits such as better attendance, better learning performance, and increased access to care.  The concept of net social benefit was calculated as total benefits minus total costs.

Of the 5,056 students, 3,673 students were enrolled in SBHC schools and 1,383 students were enrolled in schools without SBHCs.  The total net social benefit estimation of the SBHCs over the three years of the study was $1.35 million, with total costs just under $2 million and total benefits of $3.35 million.  Of interest, the resources saved from the health care sector included potential costs savings for hospitalizations estimated around $228,000, the potential savings for prescription drugs estimated around $443,000, potential prevented productivity losses around $542,000, and estimated travel expenses for parents around $42,000.  The unquantifiable benefits of the SBHCs included 1) increased care for African American children and adolescents, 2) approximately 80 percent of students returned to class after SBHC encounters, 3) increased early mental health services, 4) increased dental care, and 5) lower risk of hospitalization and emergency room visits for students with asthma.

Commentary

The traditional model of health care within our society must be questioned due to both disparities and access issues – and SBHCs provide an excellent approach.  The doctor’s office – a necessary part of the primary-care focused medical home – does not have to remain stagnant within its current physical framework.  By bringing care and resources to children where they are, our system will not only deliver more efficient care, but also allow for greater opportunities for public health outreach.  Similar to the efforts of many states to expand the opportunities  to exercise a citizen’s right to vote (e.g. in malls, by mail, on weekends, and early voting), our health care system must aim for greater creativity, flexibility, and responsiveness with the delivery of health care.

Guo, JJ, Wade, TJ, Pan, W, et al. School-Based Health Centers: Cost–Benefit Analysis and Impact on Health Care Disparities. Am J Public Health. 2010;100: 1617–1623.

NOTE: Section 4101 of the Patient Protection and Affordable Care Act provided grants for school based health clinics.

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Kameron L. Matthews, MD, Esq.