Linking Improvements in Health-Related Quality of Life to Reductions in Medicaid Costs Among Students Who Use School-Based Health Centers

School-based health centers (SBHCs) have steadily increased in numbers across the United States over the last 3 decades.

The most recent SBHC census, conducted in 2004 to 2005 by the National Assembly of School Based Health Care, identified more than 1709 SBHC programs in the United States.  This shift in the delivery of health care for children is premised on the assumption that access to health services in school increases access to health care and improves health status among children, especially for those children whose access to care is otherwise limited.  Health status is often measured by health-related quality of life (HRQOL), which attempts to tap the current health perception of individuals.  HRQOL has been demonstrated in both social scientific and clinical research to predict future health status, health care utilization and costs, and even mortality.

For example, a study linking the 1992 Medicare Current Beneficiary Survey with the 1993 Medicare Continuous History Survey found that a person’s response to a selfrated health question accurately predicted that individual’s respective use of health care services over the next year.  Only a few studies, however, have examined the connection between HRQOL and health care utilization and health care cost savings among children.  The link between HRQOL and utilization among Canadian adolescents was examined by Vingilis et al. with a single measure of perceived general health status that asked children to rank their answer on a 5-point scale from excellent to poor.  They found that reductions in perceived health over time were associated with increases in physician services and declines in dental care. This anomaly in usage across service providers may reflect differences between preventive dental care (representing the majority of dental services), which is not covered by publicly funded Canadian Medicare, and insured, curative health services.