Back to school: A health care strategy for youth

Health Affairs

Volumn 20, Issue 1, 2001, Pages 122-136

  Morone, James A ^a   Kilbreth, Elizabeth H ^b   Langwell, Kathryn M ^c  

^a BROWN UNIVERSITY   (United States)

^b UNIVERSITY OF SOUTHERN MAINE   (United States)

^c Health Economics Practice   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ADOLESCENT; ARTICLE; CHILD HEALTH CARE; ECONOMICS; GOVERNMENT; HEALTH CARE; HEALTH CENTER; HUMAN; INFORMED CONSENT; ORGANIZATION; ORGANIZATION AND MANAGEMENT; POLITICS; SCHOOL HEALTH SERVICE; UNITED STATES; VIOLENCE;

ADOLESCENT; ADOLESCENT HEALTH SERVICES; COMMUNITY HEALTH CENTERS; COMPREHENSIVE HEALTH CARE; HUMANS; ORGANIZATIONAL INNOVATION; POLITICS; SCHOOL HEALTH SERVICES; STATE GOVERNMENT; THIRD-PARTY CONSENT; UNITED STATES; VIOLENCE;

EID: 0035220089     PISSN: 02782715     EISSN: None     Source Type: Journal    
DOI: 10.1377/hlthaff.20.1.122     Document Type: Article

References (27)

1. Data on the uninsured are from a survey conducted by Wirthlin Worldwide, July 2000, reported in D. Ho, "Eligible Children Not Being Signed Up for Health Insurance," Boston Globe, 10 August 2000, A3. For a discussion of the low "take-up" rate plaguing SCHIP and Medicaid generally, see F. Thompson, "Federalism and Health Care Policy," in State Health Policy, ed. R. Hackey and D. Rochefort (Lawrence: University Press of Kansas, 2001).
2. Data on the uninsured are from a survey conducted by Wirthlin Worldwide, July 2000, reported in D. Ho, "Eligible Children Not Being Signed Up for Health Insurance," Boston Globe, 10 August 2000, A3. For a discussion of the low "take-up" rate plaguing SCHIP and Medicaid generally, see F. Thompson, "Federalism and Health Care Policy," in State Health Policy, ed. R. Hackey and D. Rochefort (Lawrence: University Press of Kansas, 2001).
3. World Health Statistics Annual: 1996 (Geneva: World Health Organization, 1998). See also 1999 Annual Report on School Safety, joint report prepared by the U.S. Departments of Education and Justice (Washington: U.S. Government Printing Office, 2000).
4. World Health Statistics Annual: 1996 (Geneva: World Health Organization, 1998). See also 1999 Annual Report on School Safety, joint report prepared by the U.S. Departments of Education and Justice (Washington: U.S. Government Printing Office, 2000).
5. Growth rate data on SBHCs are reported on two Web sites: the Robert Wood Johnson Foundation's Making the Grade site, , and the National Assembly on School-Based Health Care site, . The estimate of 1,300 comes from Julia Lear, national director, Making the Grade, personal communication, 14 October 2000, based on a national survey now being completed. Data for 1990 are from Advocates for Youth (Center for Population Options), Washington, D.C.
6. School-Based Health Centers-National Survey, 1997/1998 Report, January 1999, (6 November 2000).
7. In 1998-1999 we visited schools in multiple sites (ranging from Brooklyn, New York, to rural Oregon) across nine states as part of an evaluation of the Robert Wood Johnson Foundation's (RWJF's) Making the Grade initiative. The program is designed to encourage state development of SBHCs. The nine states were Colorado, Connecticut, Louisiana, Maryland, New York, North Carolina, Oregon, Rhode Island, and Vermont. We especially focused on the policy questions raised by the school centers. What are the advantages and the pitfalls of SBHCs? Are they financially sustainable? With what sources of funding? And what about the politics? Do communities need clinics if most children can be enrolled in an insurance program? We talked with a broad range of people including legislators, state officials, school principals, students, parents, advocates, skeptics, and health care providers.
8. D. Terry, "U.S. Child Poverty Rate Fell as Economy Grew, but Is Above 1979 Level," New York Times, 11 August 2000, A10. On immigration, see D. Tichenor, Controlling the Community (Princeton, N.J.: Princeton University Press, 2001), chap. 10.
9. D. Terry, "U.S. Child Poverty Rate Fell as Economy Grew, but Is Above 1979 Level," New York Times, 11 August 2000, A10. On immigration, see D. Tichenor, Controlling the Community (Princeton, N.J.: Princeton University Press, 2001), chap. 10.
10. P. Brodeur, "School-Based Health Clinics," in To Improve Health and Health Care 2000: The Robert Wood Johnson Foundation Anthology, ed. S.L. Isaacs and J.R. Knickman (San Francisco: Jossey-Bass, 1999). The most energetic policy entrepreneur we encountered was Julia Lear, of the RWJF's Making the Grade program.
11. Ibid. The RWJF first underwrote school health services in four states in 1978. Between 1981 and 1989 the foundation promoted community health centers in eight cities. Five of these cities established primary care centers in schools, as a part of this program. Then, in 1986, the RWJF launched the School-Based Adolescent Health Care Program and awarded nineteen six-year grants to public and private institutions to set up health centers in twenty-four high schools in fourteen cities. Finally, the Making the Grade initiative, launched in 1993, awarded grants to states to create state sponsorship, sustainable funding strategies, and regulatory oversight of SBHCs. Through these various initiatives the RWJF has, at one time or another, supported the development of school-based health care in twenty-one states. Twenty-four other states, plus the District of Columbia, have adopted the strategy.
12. The program funds thirty-three organizations to establish new school-based health centers in twenty-three states. "Healthy Schools, Healthy Communities Program," 20 April 2000, (28 July 2000).
13. Data computed from House Committee on Ways and Means, 102d Cong., 2d sess., 1992 Green Book Overview of Entitlement Programs (Washington: U.S. GPO, 15 May 1992), 1099.
14. See, for example, J.G. Dryfoos, "The Incidence and Outcome of Adolescent Pregnancy in the United States," Journal of Biosocial Science (Supplement 1978): 85-99; J.G. Dryfoos and T. Heisler, "Contraceptive Services for Adolescents: An Overview," Family Planning Perspective 10, no. 4 (1978): 223-225,229-233; J.G. Dryfoos, "What President Bush Can Do about Family Planning" (editorial), American Journal of Public Health 79, no. 6 (1989): 689-690; and J.G. Dryfoos, "School-Based Health Clinics: Three Years of Experience," Family Planning Perspective 20, no. 4 (1988): 193-200.
15. See, for example, J.G. Dryfoos, "The Incidence and Outcome of Adolescent Pregnancy in the United States," Journal of Biosocial Science (Supplement 1978): 85-99; J.G. Dryfoos and T. Heisler, "Contraceptive Services for Adolescents: An Overview," Family Planning Perspective 10, no. 4 (1978): 223-225,229-233; J.G. Dryfoos, "What President Bush Can Do about Family Planning" (editorial), American Journal of Public Health 79, no. 6 (1989): 689-690; and J.G. Dryfoos, "School-Based Health Clinics: Three Years of Experience," Family Planning Perspective 20, no. 4 (1988): 193-200.
16. See, for example, J.G. Dryfoos, "The Incidence and Outcome of Adolescent Pregnancy in the United States," Journal of Biosocial Science (Supplement 1978): 85-99; J.G. Dryfoos and T. Heisler, "Contraceptive Services for Adolescents: An Overview," Family Planning Perspective 10, no. 4 (1978): 223-225,229-233; J.G. Dryfoos, "What President Bush Can Do about Family Planning" (editorial), American Journal of Public Health 79, no. 6 (1989): 689-690; and J.G. Dryfoos, "School-Based Health Clinics: Three Years of Experience," Family Planning Perspective 20, no. 4 (1988): 193-200.
17. See, for example, J.G. Dryfoos, "The Incidence and Outcome of Adolescent Pregnancy in the United States," Journal of Biosocial Science (Supplement 1978): 85-99; J.G. Dryfoos and T. Heisler, "Contraceptive Services for Adolescents: An Overview," Family Planning Perspective 10, no. 4 (1978): 223-225,229-233; J.G. Dryfoos, "What President Bush Can Do about Family Planning" (editorial), American Journal of Public Health 79, no. 6 (1989): 689-690; and J.G. Dryfoos, "School-Based Health Clinics: Three Years of Experience," Family Planning Perspective 20, no. 4 (1988): 193-200.
18. J.J. Elders, Jaycelyn Elders, M.D.: From Sharecropper's Daughter to Surgeon General of the United States of America (New York: Avon Books, 1996), 242.
19. SBHCs offer efficiencies through their use of mid-level practitioners. However, the lower salary costs of the staff may be offset by the longer visit time taken with each student. Obviously, the major reason that SBHCs are low cost is because they are, so far, small programs. Costs will increase as the programs expand to reach more children. However, one thing making SBHCs politically attractive is that they can be carefully targeted and incrementally funded.
20. Act 1055, House Bill no. 169L, signed by Louisiana Governor Charles E. "Buddy" Roemer II (R), 1991.
21. The controversy occurred in October 1999. See "Angry Parents Storm State Capitol to Protest School Health Bill," Associated Press, 1 October 1999.
22. Managed care organizations require that their primary care gatekeepers provide access twenty-four hours a day, seven days a week for their patients, so that persons with acute or emergency conditions can get medical advice or authorization for emergency care at any time. This means that even physicians in solo practices have to have arrangements with colleagues to cover for each other twenty-four hours a day. Most SBHCs operate only during school hours and are closed for the summer and are thus not positioned to share on-call requirements with full-time medical practices.
23. Lear, personal communication. See also J. Koppelman and J.G. Lear, From the Margins to the Mainstream: Institutionalizing School-Based Health Centers (Washington: Making the Grade, George Washington University, June 2000).
24. Lear, personal communication. See also J. Koppelman and J.G. Lear, From the Margins to the Mainstream: Institutionalizing School-Based Health Centers (Washington: Making the Grade, George Washington University, June 2000).
25. See Thompson, "Federalism and Health Care Policy."
26. J.A. Morone, The Democratic Wish Popular Participation and the Limits of American Government, 2d ed. (New Haven: Yale University Press, 1998).
27. See, for example, "Rethinking Zero Tolerance," editorial in the Boston Globe, 17 August 2000, A19.