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Economic Evaluation of School-Based Health Centers

A Community Guide Systematic Review
  • Tao Ran
    Correspondence
    Address correspondence to: Tao Ran, PhD, Community Guide Branch, CDC, 1600 Clifton Road, MS E-69, Atlanta GA 30329-4207
    Affiliations
    Community Guide Branch, Division of Public Health Information Dissemination, Center for Surveillance, Epidemiology, and Laboratory Services, CDC, Atlanta, Georgia
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  • Sajal K. Chattopadhyay
    Affiliations
    Community Guide Branch, Division of Public Health Information Dissemination, Center for Surveillance, Epidemiology, and Laboratory Services, CDC, Atlanta, Georgia
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  • Robert A. Hahn
    Affiliations
    Community Guide Branch, Division of Public Health Information Dissemination, Center for Surveillance, Epidemiology, and Laboratory Services, CDC, Atlanta, Georgia
    Search for articles by this author
  • the Community Preventive Services Task Force

      Context

      A recent Community Guide systematic review of effectiveness of school-based health centers (SBHCs) showed that SBHCs improved educational and health outcomes. This review evaluates the economic cost and benefit of SBHCs.

      Evidence acquisition

      Using economic systematic review methods developed for The Community Guide, 6,958 papers were identified for the search period January 1985 to September 2014. After two rounds of screening, 21 studies were included in this review: 15 studies reported on cost and nine on benefit; three studies had both cost and benefit information. All expenditures in this review were presented in 2013 U.S. dollars.

      Evidence synthesis

      Analyses were conducted in 2014. Intervention cost had two main components: start-up cost and operating cost. All but two of the cost studies reported operating cost only (ranging from $16,322 to $659,684 per SBHC annually). Benefits included healthcare cost averted and productivity and other loss averted. From the societal perspective, total annual benefit per SBHC ranged from $15,028 to $912,878. From healthcare payers’ perspective, particularly Medicaid, SBHCs led to net savings ranging from $30 to $969 per visit. From patients’ perspective, savings were also positive. Additionally, two benefit studies used regression analysis to show that Medicaid cost and hospitalization cost decreased with SBHCs. Finally, results from seven estimates in two cost–benefit studies showed that societal benefit per SBHC exceeded intervention cost, with the benefit–cost ratio ranging from 1.38:1 to 3.05:1.

      Conclusions

      The economic benefit of SBHCs exceeds the intervention operating cost. Further, SBHCs result in net savings to Medicaid.
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