School-Based Health Centers: Cost-Benefit Analysis and Impact on Health Care Disparities

Objectives. We evaluated the impact of school-based health centers which provide essential health care for students by aiming to eliminate many access barriers on health care access disparities and conducted a cost-benefit analysis. Methods. We employed a longitudinal quasi-experimental repeated-measures design. Primary data sources included the Ohio Medicaid claims, enrollment file with race/ethnicity, and survey reports from parents. We used hierarchical linear modeling to control unbalanced data because of student attrition. We assessed quarterly total Medicaid reimbursement costs for 5056 students in the SBHC and non-SBHC groups from 1997 to 2003. We calculated net social benefit to compare the cost of the SBHC programs with the value that SBHCs might save or create. Results. With SBHCs, the gap of lower health care cost for African Americans was closed. The net social benefits of the SBHC program in 4 school districts were estimated as $1352087 over 3 years. We estimated that the SBHCs could have saved Medicaid about $35 per student per year. Conclusions. SBHCs are cost beneficial to both the Medicaid system and society, and may close health care disparity gaps. (Am J Public Health. 2010;100: 1617-1623. doi:10.2105/AJPH.2009.185181)