Don’t Limit Students’ Health Care Options

Educators and university administrators must soon decide how to manage the plethora of issues facing the billion-dollar student-health industry or a health crisis on the nation’s campuses may be approaching.

Highest on the list is funding: Health-center costs are growing at about 8% annually. But tuition has soared so much in recent years that schools, faced with declining enrollments, are hard-pressed to raise tuition even more for health care.

In the last decade, tuition has, on average, risen 46% at private colleges and 54% at public four-year universities (adjusted for inflation), according to the U.S. Department of Education. Yet, the percentage of tuition revenue allocated to campus health centers has fallen by two-thirds. Universities, therefore, have turned to mandatory student fees to close the funding gap.

Spiraling costs have resulted, in part, from risky student behavior. For example, a study of 1,408 Texas college students earlier this year found that 47% do not regularly participate in any aerobic activity; 21% have driven under the influence of alcohol; 31% regularly smoke; 8% have used cocaine and that only 40% used condoms during their most recent sexual experience. The consequences of such behavior can be quite expensive.

Further complicating matters are the centers’ poorly understood role in the medical community and questions regarding their governance. “There is no clearly defined role in the U.S. health-care system for college health, and traditional health-care customers do not advocate for college health,” says Dr. Lawrence Neinstein, executive director of the USC Student Health Center.

Reinforcing this vagueness of purpose is the fact that those who make the key decisions about student health-care funding often know little about the specific economics of health care. At many institutions, health centers are a subdivision of the student-affairs office, which oversees a myriad of non-classroom services. At USC, the Office of Student Affairs determines the budget for the school’s health center and for approximately 30 other programs and divisions.

In rural areas, the situation is dire. A 1995 study found that campus health centers are, for many students, the only option because of a shortage of primary-care physicians outside the university setting. Closing any of these centers would be a medical emergency in itself, the study found.

The access-to-care problem is compounded by the fact that as many as 48% of college students nationwide are uninsured or underinsured, according to the Journal of Higher Education. Because they are students, the uninsured are ineligible for public medical assistance. For millions of students, campus health centers are the sole provider of care.

Since a large infusion of funds is unlikely, student health centers may be forced to execute a common business ploy: Instead of raising their prices, they may offer fewer services for the same price. The danger is that those who depend on the centers may not realize that they are receiving less than 100% of the care they could get.

Still, the centers have an enviable track record of keeping costs in check. While health costs nationally have tripled in the last 30 years, to 15% of gross national product, student health centers have kept their costs low and the quality of care provided high, with guaranteed access to all, through a prepaid setup. Within this framework, a primary-care approach with emphases on education, prevention and wellness has thrived.

History shows that this approach to health care works. For it to continue, schools will have to allocate their increasingly scarce resources more wisely. The health of 12 million students depends on it.