Health Care + Education = Healthy Communities: Why Schools Fit the Equation

SCHOOL HEALTH INITIATIVES MIDWESTERN REGIONAL CONFERENCE

July 23-24, 2008

Sponsored in part by:

ICSHC

National Covering Kids & Families Network

Healthcare + Education = Healthy Communities: Why

Schools Fit the Equation

Kate Keller, MPASenior Program Officer

The Health Foundation of Greater Cincinnati

National Picture of SBHCs

• Over 1700 SBHCs in 2005

• 87% located in the school building

• 30% high schools; 80% serving at least one adolescent grade

• 34% Hispanic; 30% Black; 30% White

• 59% in urban areas

• Midwest region: 275 SBHCs

Who we serve

• 12 School-Based Health Centers

• 31 Schools Served

• 8,050 students enrolled (76% of student population)

• 52% Medicaid; 16% uninsured

• 16,791 encounters

What we learned

Improved Health Status

Child-Reported Total HRQL (N=588)

70

72

74

76

78

80

Year 1 Year 2 Year 3

Ped

sQL

Sco

re

SBHC User SBHC NonUser Comparison

What we learned

Improved mental health status

Child-Reported Psychosocial HRQL (N=588)

68

70

72

74

76

78

Year 1 Year 2 Year 3

Ped

sQL

Sco

re

SBHC User SBHC NonUser Comparison

What we learned

Attendance success varied

SBHC Visit Outcome

50%

60%

70%

80%

90%

100%

Year 1 Year 2 Year 3

Returned to Class Dismissed Other

N=3707 N=5080 N=6354

Yearly Absences among Those Reporting ADHD across SBHC Users, Nonusers and

Comparison

5

10

15

20

25

Year 1 Year 2 Year 3

Ave

rage

Abs

ence

s

SBHC User SBHC NonUser Comparison

Note: Statistical 3-way interactionNote: Statistical 3-way interaction

What we learned

Improved access to healthcare

Percent of Parents Reporting Perceived Problems getting

Health Care (N=581)

0

5

10

15

20

25

30

Year 1 Year 2 Year 3

Per

cent

SBHC User SBHC NonUser Comparison

What we learned

Medicaid costs did not increase

Trend of Total Medicaid Costs by SBHC per 100 Students for 22 quarters(N=2153)

0

10000

20000

30000

40000

50000

60000

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22

Quarter (Sept 1997 - Feb 2003)

Qua

rterly

Tot

al C

ost

TC_NonSBHC TC_SBHC

SBHC

What we learned

Medicaid savings for a rural SBHC

Total Quarterly Medicaid Costs for Rural Schools per 100 Students (N=725)

0

5000

10000

15000

20000

25000

30000

35000

40000

45000

50000

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22

Quarter (Sept 1997 - Feb 2003)

Tot

al Q

uart

lery

Cos

t

TC_NonSBHC_Rural TC_SBHC_Rural

SBHC

What we learned

Closed the gap of healthcare services for African-American students

Growth Trend of Quarterly Total Costs by Race (N=5056)

-12.00 -7.80 -3.60 0.60 4.80 9.00

Total Cost by Race

Quarter (Sept 1997 - Feb 2003)

0.0

43.7

87.3

131.0

174.7

218.4

262.0

305.7

349.4

393.1

436.7

Total Cost

Other RACE = 0

black = 1

Racial Disparity:

African Americans with low costs at the initial point, then, overcame the difference with SBHC.

What we learned

Significant Medicaid savings for

students with asthma

Numbers of Hospitalization and ER Visits for Children with Asthma in SBHC Schools (N=196)

and Non-SBHC Schools (N=77)

36

12

344

307

11 10

200210

0

50

100

150

200

250

300

350

400

Hospital-Before Hospital-After ER-Before ER-After

Before - After SBHC

Hos

pit

aliz

atio

n o

r E

R V

isit

s

SBHC Non-SBHC

With SBHC, hospitalizations decreased 3-fold.

Hospitalization Costs Before and After SBHC for Students with Asthma (N=273)

Estimated Marginal Means of HOSPCOST

TIME

21

Est

ima

ted

Ma

rgin

al M

ea

ns

1400

1200

1000

800

600

400

200

0

SBHC

0

1

Hospitalization costs decreased $970 per student.

SBHC

What we learned

Increased use of mental health services

Medicaid Mental Health Service Costs before and after the SBHC Program for Students with Mental

Health Problems (N=551)

Estimated Marginal Means of MENTCOST

TIME

21

Est

ima

ted

Ma

rgin

al M

ea

ns

4000

3000

2000

1000

SBHC

.00

1.00

Students with mental health illnesses had more mental service costs.

SBHC

For full study results see:

http://www.healthfoundation.org/sbhcstudy.html

Contact:Kate Keller

kkeller@healthfoundation.org