Locating Health Care Personnel and Clinical Services in Schools Saves Money and Improves Student Health

Prevention Case Study 5

School nurses provide valuable medical care to students, thereby  improving the students’ health and school attendance, while increasing parent and teacher productivity and reducing medical costs.1-9  Services provided by school nurses range from general care (e.g., wound care and body temperature monitoring), to treating chronic diseases (e.g., diabetes and asthma) and providing preventive care (e.g., administering vaccinations and sexually transmitted disease [STD] and pregnancy prevention counseling).10-13

  • A case study of the Massachusetts Essential School Health Service (ESHS) Program delivered by full-time registered nurses documented that for every dollar invested in the program, society gained $2.20 from reduced medical costs and increased parent and teacher productivity.11 A total of 477,163 students in 933 Massachusetts schools received ESHS during the 2009–10 school year from a full-time school nurse.11
  • On the basis of the most recent data (2007), only 45% of U.S. public schools have a full-time on-site nurse; 30% have a part-time nurse, and 25% have no school nurse.14

School-based health centers (SBHCs), like school nurses, provide valuable medical care to students by improving their health and school attendance. SBHCs also increase parent and teacher productivity and reduce medical costs.15 SBHC services are more comprehensive than those typically provided by a school nurse and often include physical and mental health assessments; vision, hearing, and other screening services; vaccinations; STD screening and treatment; pregnancy testing, and contraceptive counseling and services.15

  • A Community Guide systematic economic review concluded the following:
    • From a health care payers’ perspective, particularly Medicaid, SBHCs led to a net savings of $30–$969 per visit.16
    • For every dollar invested in SBHCs, society gained $1.38–$3.05 through reduced medical costs, increased parent and teacher productivity, and costs averted (e.g., travel costs and ambulance use).16
    • Based on the most current data available (2013-2014 school year), only 2.4% of the nation’s public schools have SBHCs. 17-18

CDC supports local and state education agencies in promoting student access to health services

CDC funds local and state education agencies to help prevent human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) and STDs among adolescents and increasing academic success. One of CDC’s key programmatic strategies is to improve schools’ capacity for increasing adolescents’ access to key preventive sexual health services, either by providing on-site services or making referrals to adolescent-friendly community-based health service providers. CDC provides program guidance regarding how to increase student access to school health services. More information is available at Health Services for Teens.

  1. Vollinger LJ, Bergren MD, Belmonte-Mann F. Substitutes for school nurses in Illinois. J Sch Nurs 2011;27:111–9.
  2. Noyes K, Bajorska A, Fisher S, Sauer J, Fagnano M, Halterman JS. Cost-effectiveness of the School-Based Asthma Therapy (SBAT) program. Pediatrics 2013;131:e709–17.
  3. Weismuller PC, Grasska MA, Alexander M, White CG, Kramer P. Elementary school nurse interventions: attendance and health outcomes. J Sch Nurs 2007;23:111–8.
  4. Telljohann SK, Dake JA, Price JH. Effect of full-time versus part-time school nurses on attendance of elementary students with asthma. J Sch Nurs 2004;20:331–4.
  5. Pennington N, Delaney E. The number of students sent home by school nurses compared to unlicensed personnel. J Sch Nurs 2008;24:290–7.
  6. Wyman LL. Comparing the number of ill or injured students who are released early from school by school nursing and nonnursing personnel. J Sch Nurs 2005;21:350–5.
  7. Allen G. The impact of elementary school nurses on student attendance. J Sch Nurs 2003;19:225–31.
  8. Hill NJ, Hollis M. Teacher time spent on student health issues and school nurse presence. J Sch Nurs 2012;28:181–6.
  9. Baisch MJ, Lundeen SP, Murphy MK. Evidence-based research on the value of school nurses in an urban school system. J Sch Health 2011;81:74–80.
  10. Fauteux N. Unlocking the potential of school nursing: keeping children healthy. Issue 14 of the Charting Nursing’s Future series looks at keeping children healthy, in school, and ready to learn. Washington, DC: Robert Wood Johnson Foundation; 2010.
  11. Wang LY, Vernon-Smiley M, Gapinski MA, Desisto M, Maughan E, Sheetz A. Cost-benefit study of school nursing services. JAMA Pediatr. 2014;168:642–8.
  12. Dittus PJ, De Rosa CJ, Jeffries RA, Afifi AA, Cumberland WG, Chung EQ, Martinez E, Kerndt PR, Ethier KA. The project connect health systems intervention: linking sexually experienced youth to sexual and reproductive health care. J Adolesc Health. 2014 Oct;55(4):528-34.
  13. Dittus PJ, Harper CR, Becasen JS, Donatello RA, Ethier KA.Structural Intervention With School Nurses Increases Receipt of Sexual Health Care Among Male High School Students. J Adolesc Health. 2017 Nov 2. pii: S1054-139X(17).
  14. Burkhardt Research Services. School Nursing in the United States: A Quantitative Study. Silver Spring, MD: National Association of School Nurses; 2007.
  15. Keeton V, Soleimanpour S, Brindis CD. School-based health centers in an era of health care reform: building on history. Curr Probl Pediatr Adolesc Health Care 2012; 42:132–56.
  16. Ran T, Chattopadhyay SK, Hahn R; the Community Preventive Services Task Force. Economic evaluation of school-based health centers. Am J Prev Med 2016;51:129–38.
  17. U.S. Department of Education, National Center for Education Statistics. (2016). Digest of Education Statistics, 2015 (NCES 2016-014), Table 105.50.
  18. School-Based Health Alliance. 2013-2014 Census Report of School-Based Health Centers. Available at School-Based Health Alliance
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