Access to health care providers continues to be a problem for children in Texas. Barriers to access include lack of health insurance and the inability to come to provider appointments due to challenges faced by parents. Medical care for children is important because early recognition and treatment of chronic illnesses decreases the impact of disease in adulthood. In addition, early interventions decrease costs to the health care system.
One solution to increasing access for children is through school-based health centers (SBHC). An SBHC is run very much like a traditional doctor’s office, with the exception that most are staffed by nurse practitioners. SBHCs were first conceived in the 1970s as a way to reduce health-related absences and improve access to care for underserved children. Nearly 2,000 SBHCs have been in operation nationwide since the 1970s. Under the Affordable Care Act (ACA), $200 million was appropriated toward the improvement and expansion of SBHCs between 2010 and 2013. School-based health centers are typically funded through a mix of private, government, in-kind, foundation and Medicaid dollars. However, funding is not always stable and the operational and staff costs of running the clinics are high.
School nurses are a less expensive alternative to SBHCs. School nurse programs pre-date SBHCs and have existed since the early 1900s. School nurses can mange chronic conditions, perform health screenings and immunizations, provide health education, and triage acute illnesses — all of which take care of the majority of health-related problems for children. The disadvantage of the school nurse program compared to the SBHC is that nurses are not licensed to diagnose and treat conditions, and therefore a referral to a higher licensed provider, such as a nurse practitioner or physician, would be required at times. Funding can also be challenging because as public school financing becomes tighter, school nurses are often cut first, leaving some schools without a school nurse and others with a nurse only one or two days a week.
Telehealth in schools may be the answer to limited resources and a need to increase health care access for kids. Telehealth refers to the use of information and communications technology to deliver a broad range of health care services remotely, including clinical care, health education and counseling. Based on our experience, the telecommunications equipment needed in a school clinic can be as simple as a computer, Web cam, encrypted software, electronic stethoscope and video otoscope. Therefore, the cost of setting up a telehealth system can be relatively small.
Telehealth in school could maximize the benefits of a school nurse program, while also permit access to physicians or mental health providers, as needed. The latter component, accessing higher licensure providers, has been the emphasis of other school telehealth programs around the country. These programs were primarily designed to increase student access to physicians or mental health providers, with little focus on addressing the issue of limited school nurses in the district.
However, maximizing access to school nurses is a more cost-effective model for keeping kids healthy and in school. School nurses engage in a number of preventative health services, triage acute illnesses and manage chronic conditions, which are the majority of services needed in a school setting. Instead of creating a telehealth model focused on accessing physicians, a telehealth model that increases access to school nurses may produce similar outcomes and be less expensive — and students could still access outside physicians as needed via the telehealth equipment, and those physicians could be reimbursed through the students’ health insurance. Limited budgets for school nurses would continue to remain a problem, but telehealth could optimize the nurses currently employed by school districts by permitting greater access.
There will never be a “one-size fits all” solution to our health care crisis, but telehealth may be a viable option to, at the very least, provide kids with access to a health care professional in school, which has been shown to reduce absenteeism and improve management of chronic illnesses in children.
Quianta Moore, M.D., is a Baker Institute Scholar in Health Policy. Her research focuses on equitable access to health care and improving the health of children through school-based clinics and telemedicine. Moore received a Bachelor of Arts in sociology from Cornell University, a J.D. from the University of Houston Law Center and an M.D. from Baylor College of Medicine.