School-Based Health Centers, Access to Care, and Income-Based Disparities

Area of Science:

• Public Health
• Health Services Research
• Pediatric Health

Background:

• School-based health centers (SBHCs) are primary care clinics in schools, aiming to improve healthcare access and reduce disparities.
• Rigorous evidence on the national effectiveness of SBHCs is limited.

Purpose of the Study:

• To assess the association between county-level SBHC adoption and healthcare access, utilization, and health outcomes for low-income children.
• To quantify reductions in income-based disparities in healthcare access and utilization.

Main Methods:

• A difference-in-differences study design using nationally representative survey data (1997-2018).
• Analysis included children aged 5-17 from low-income families (<200% federal poverty level) and higher-income families.
• Compared outcomes in counties adopting SBHCs between 2003-2013 versus those without SBHCs.

Main Results:

• SBHC adoption was linked to increased dental visits (+6.4%), usual source of care (+8.0%), and insurance rates (+5.2%).
• SBHCs were associated with significant relative reductions in income-based disparities for dental visits (76%), insurance (63%), and usual source of care (98%).
• No significant associations were found for other measured health or utilization outcomes.

Conclusions:

• SBHC adoption is associated with improved healthcare access and reduced income-based disparities among children.
• Findings support the expansion of school-based health centers to enhance pediatric healthcare access and equity.