Impact of School-Based Health Centers on Improving Health and Promoting Equity

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Project Summary Disparities in health outcomes and access to care for children and adolescents are large and persistent, with worse outcomes observed among children and adolescents who are Black and Hispanic, enrolled in Medicaid, live in low-income households, and live in rural areas. School-based health centers (SBHCs) may help to promote health equity by making care more accessible and affordable to school-aged children, meaning SBHCs are well-positioned to reduce disparities in health care use and health outcomes. Prior research generally suggests benefits from SBHCs. However, most studies only examine a few SBHCs and report correlational associations rather than causal evidence. This proposed study of SBHCs in California and Oregon will overcome the limitations of prior studies by using a large sample and rigorous causal inference methods. Because both states have experienced recent growth in SBHCs, we will exploit variation in availability of SBHCs over time and across schools to compare the impact of SBHCs on students before and after the opening of SBHCs in treatment schools (with SBHCs) and control schools (without SBHCs). Using multiple years of health insurance claims data, survey data, and education data, we will: (1) characterize SBHCs, including the services they provide, the patients receiving care at SBHCs, and changes since the start of the COVD-19 pandemic; (2) estimate the impact of SBHC access on health care utilization, cost, health outcomes, and education outcomes overall and for members of health disparity populations (defined by race/ethnicity, household income, and rurality); and (3) examine the dimensions on which SBHC characteristics vary, including location, services offered, size, and the pandemic to inform the operation of current SBHCS and design of future SBHCs. The proposed research is timely and important due to longstanding and new barriers to health care and the increasing recognition of the importance of schools in promoting the healthy development of children and adolescents.