Health Care Reform

GAO's work suggests that school-based health centers--facilities located on a school's grounds that provide preventive, medical, and mental health care services to students--do improve children's access to health care. The centers can help to overcome financial and nonfinancial barriers that now limit access, including the lack of health insurance, transportation difficulties, and insufficient attention to the needs of adolescents. School-based centers around the nation face a common set of problems. For example, centers lack a stable source of funding, do not always have enough resources for meeting their patients' health needs, and have difficulty obtaining reimbursement from public and private insurers. They also face problems recruiting and retaining appropriately trained staff. Furthermore, local debates over the appropriateness of reproductive health services in these centers have hampered their ability to meet some adolescents' health needs. Federal health care reform that increases access to insurance coverage could alleviate some of the centers' problems. However, reform that expands the role of managed care networks may worsen financial problems because of the reluctance of these networks to reimburse centers.

GAO found that: (1) SBHC can improve children's access to health care and help families overcome financial and nonfinancial barriers that limit access; (2) SBHC attempt to provide health services to families that lack health insurance or experience transportation difficulties, and address adolescents with special needs; (3) SBHC lack a stable source of funding, do not have sufficient resources for meeting their patients' health care needs, and have difficulty obtaining reimbursement from public and private insurers and recruiting and retaining appropriately trained staff; (4) SBHC ability to meet some adolescents' health needs has been constrained because of local debates over the appropriateness of providing reproductive health services; (5) federal health care reform could increase access to insurance coverage and alleviate some SBHC problems; and (6) reforms that promote managed care networks could exacerbate financing problems because of the networks' reluctance to reimburse SBHC.