This article was downloaded by: [Temple University Libraries] On: 20 November 2014, At: 22:31 Publisher: Routledge Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK
Journal of American College Health Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/vach20
College Health Services in California a
a
Robert C. Davidson MD, MPH , John M. Chuck MD & Suzanne Snively MD
a
a
Department of Family Practice , University of California, Davis School of Medicine , Sacramento, California, USA Published online: 09 Jul 2010.
To cite this article: Robert C. Davidson MD, MPH , John M. Chuck MD & Suzanne Snively MD (1991) College Health Services in California, Journal of American College Health, 40:3, 131-134, DOI: 10.1080/07448481.1991.9936269 To link to this article: http://dx.doi.org/10.1080/07448481.1991.9936269
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http://www.tandfonline.com/page/termsand-conditions
College Health Services in California
Downloaded by [Temple University Libraries] at 22:31 20 November 2014
Robert C. Davidson, MD, MPH; John M. Chuck, MD; and Suzanne Snively, MD
Abstract. College health services are an underrecognized segment of California’s health delivery system. Higher education institutions in California vary in their arrangements for the provision of health services. Some of the smaller institutions provide nurse triage, first aid, and referral only, whereas other institutions provide %-hour-per-day/7-day-per-week comprehensive ambulatory and inpatient services. More than 200 fulltime equivalent physicians are employed in college health services in California. Patient profiles served by college health services targeted the traditional college student age range. Some institutions, however, have expanded their services to include nonstudent university employees and their dependents. Comparing numbers of outpatient visits and professional staffing requirements to student enrollment showed significant variability between institutions, depending upon the scope of services provided (basic, intermediate, comprehensive) and the type of student population (residential, commuter, mixed). Key Words. College health, scope of services, staffing issues
C
ollege health services are an underrecognized segment of our nation’s health system. Student health services in the 10 largest (by enrollment) public and the 10 largest private institutions in the country were described in a 1988 study by Patrick.’ National statistics show that there are more than 3,400 institutions of higher education in the United States. Enrollment in these institutions in 1988 totaled 12.8 million ~tudents.’.~The American College Health Association estimates that 1,500 of these institutions in some way provide health services for 10 million students. California has an extensive system of public higher education institutions, in line with a state Master Plan for Higher Education developed under the auspices of then University of California president Clark K ~ I TThe .~ state plan provides for three multicampus higher educaThk article comesfrom the Department of Family Practice, University of California, Davk School of Medicine, Sacramento, California. Robert C. Davidson k associate professor and chair; John M. Chuck k a staff physician at Kaker Medical Center in Fairfield, California, and, at the time of the study, was chief resident in family practice; and Suzanne Sniveb is clinical professor of internal medicine. Dr Snively was formerly director of student health services at California State University, Sacramento. VOL 40, NOVEMBER 1991
tion systems, including the 2-year California Community Colleges, the California State University, and the
University of California. In addition, California has 181 independent degree-granting private colleges and univer~ities.~ Together, these California institutions have an annual budget exceeding $15 billion, and an enrollment that in 1987 totaled 1,923,631.5*6 Many of these institutions provide health services to students and, in some cases, to staff and faculty. Information regarding this segment of our health delivery system is not well delineted, which prompted the authors to carry out this survey. METHOD
We sent a questionnaire to the directors of all identified student health centers (SHCs) in California (N = 159). The list was compiled from several directories of student health service organizations. It is possible that the survey may have missed some institutions that provide student health services but are not associated with any student health service organization. The survey requested information on (1) general characteristics of the educational institution; (2) types of health services provided; (3) profile of patients cared for in the SHC; and (4) professional staffing of the SHC. Following the initial mailing, a second mailing was sent to nonrespondents, and we made telephone contact with directors to urge cooperation. RESULTS
Of the 159 educational institutions surveyed, 117 (74%) responded. Although all institutions were identified from lists of student health organizations, only 92 of the 117 respondents reported that they were currently operating SHCs. These 92 institutions constituted the study PoPulation. The 25 institutions that reported operating no SHCs were all 2-Year COmmUnitY Colleges. The majority of institutions that did not respond to the survey were also 2-year community colleges. only3 institutions that were Cyear institutions with student to expect student health enrollment large centers did not respond. The response rate of institu131
COLLEGE HEALTH
TABLE 1 Student Population Size of California Institutions With Student Health Centers
< 2,000
Downloaded by [Temple University Libraries] at 22:31 20 November 2014
2,000-5,000 5,000-10,000 10,000-20,000 > 20,000 No response Total
2-year schools Yo n
4-year schools n Yo
n
Yo
2 4 12 19 10 4 51
6 8 9 8 9 1 41
8 12 21 27 19 5 92
9 13 23 29 21 5 100
4 8 23 37 20 8 100
15 19.5 22 19.5 22 2 100
Total
TABLE 2 Type of Student Population of California Student Health Centers
Residential Commuter Mixed No response Total
2-vear schools n Yo
4-year schools n Yo
3 41 5 2 51
13 13 14 1 41
6 80 10 4 100
tions expected to provide student health services was, therefore, much higher than the actual rate of 74%. The size of the student population at institutions providing health services varied from small (< 2,000) to 19 institutions with more than 20,000 students (Table 1). The terms university, college, and community college are sometimes self-designated and do not indicate size or types of programs offered. Therefore, for clarity, we divided respondent institutions into 2-year and 4-year institutions. The student populations were self-described by the institutions as predominantly residential (students living on or near campus), commuter, or mixed (Table 2). Four-year institutions showed a mix of all three types, but most 2-year schools had commuter students. The types of health services provided were categorized as basic, intermediate, or comprehensive. Basic was considered first aid only, intermediate services were defined as primary care with basic laboratory facilities, and comprehensive services included primary and specialty physician services,.X-ray and laboratory diagnostic services, in-house pharmacy, and in-house counseling services. The majority (54%) of the 4-year schools provided comprehensive services, whereas most (63%) 2-year schools provided basic services only (Table 3). Most institutions (82%) provided ambulatory services only, although 5 institutions had inpatient beds as part of the student health service, and an additional 4 provided inpatient services at another hospital. Most SHCs (75%) were open weekdays. Some of the larger 4-year 132
32 32 34 2 100
Total
n
Yo
16 54 19 3 92
17 59 21 3 100
institutions and all of those with inpatient beds provided 7-day-per-week/24-hour-per-day service. Four-year schools averaged 140 outpatient visits per day, and the 2-year schools averaged only 40 visits per day. Most (89%) visits to SHCs were by registered students, although at one institution, 60% of the visits were by nonstudents. The number of student visits to the SHC in relation to total student population of the institution varied widely from a low ratio of 0.08 visits per 1,OOO enrolled students per day (a 2-year community college with commuter students and only basic health services provided) to a high of 23.8 visits per 1,000 enrolled students (a 4-year residential university with comprehensive services). The number of student visits per day to the SHC in relation to campus student enrollment was closely correlated with the percentage of students living on campus (residential). The average of all institutions that listed their student population as predominantly residential was a visit rate of 11.9 visits per 1,OOO enrolled students per day. Institutions that described their student population as mixed residential/ commuter averaged 9.3 visits per 1,000 enrolled students per day; those that were commuter schools reported an average rate of 4.5 visits per 1,000 enrolled students per day. The age of students served at SHCs was, as expected, an average of 25.2 years. Two-year schools had a slightly older average student age (27.1 years) than 4-year schools (22.7 years) (Table 4). The youngest student served at a California SHC was 12 years old, and the JACH
CALIFORNIA HEALTH SERVICES
Downloaded by [Temple University Libraries] at 22:31 20 November 2014
TABLE 3 Types of Services Provided at California Student Health Centers 2-year schools n VO
4-year schools
n
Vo
n
VO
Basic Intermediate Comprehensive No response Total
32 12 3 4 51
63 23 6 8 100
10 7 22 2 41
24
42 19 25 6 92
46
17 54 5 100
21 27 6 100
Ambulatory only On-campus inpatient Off-campus inpatient No response Total
46
90
29 5 4 3 41
71 12 10 7 100
75 5 4 8 92
82 5 4 9 100
1 26 9 3 2 41
2.5 63.5 22 7 5 100
6 69 9 6 2 92
6.5 75 10 6.5 2 100
Part-time weekdays Weekdays 7 days124 hrs Other No response Total
-
-
5
5 100
51
10 84
5
43 3
-
-
-
51
100
6
Total
TABLE 4 Age of Population Served at California Student Health Centers 2-year schools
4-year schools
Total ~
Age-student visits M Mdn Range Age-nonstudent visits M Mdn
27.1 27.0 19.0-35.0
22.7 22.5 19.0-30.0
25.2 25.0 19.0-35.0
40.3 40.0
38.6 40.0
40.0
oldest student was 90 years old. The average age of nonstudents served at the California SHCs was 39.6 years. This population comprised faculty and staff at the institution. Some institutions provided dependent care, but most provided nonstudent services only to employees of the institution. The professional staffing of California SHCs was quite varied, with combinations of full- and part-time physicians, nurse practitioners, physician assistants, and nurses. The average institution had a staff of 2.4 physicians, 1.3 nurse practitioners, 0.1 physician assistants, and 2.7 registered nurses. When all institutions were combined, the physician staffing average was 1 physician per 5,311 enrolled students. In addition, the average institution had a staffing of 1 nonphysician health provider per 3,217 enrolled students. Other health providers in this study included only nurse practitioners, physician assistants, and registered nurses. We found a marked variation in professional staffing, depending upon the type of service offered and living arrangements VOL 40, NOVEMBER 1991
~ ~ _ _ _ _
39.6
of the students. The ratio of physician and other health providers to student enrollment in relation to these variables is shown in Table 5. The total full-time equivalent (FTE) number of phyicians employed in California student health centers was 215.5. In addition, 113.7 FTE nurse practitioners, 6.0 FTE physician assistants, and 235.7 registered nurses work in California SHCs. DISCUSSION Health services provided by California institutions of higher education are often an unrecognized segment of the state health system. Reliable data regarding the overall cost of California SHCs could not be obtained in this study. Income for SHCs comes from a combination of student health fees and billing for services provided, either directly to the client as a co-payer or to the client’s insurance. Many students are covered under the health insurance policy of their parents. Most institutions do not provide direct dollar support to SHCs except through student fees. Many institutions, however, pro133
COLLEGE HEALTH
TABLE 5 Full-Time Equivalent (FTE) Professionals to Student Enrollment, by Type of Student Housing Arrangement and Scope of Services Offered
I FTE physician: Student population
FTE other health provider: Student population
123,517 1:3,444 1:2,098
1:4,676 1:2,104 1:1,454
1:22,297 1:9,545 1:2,940 15,311
1:5,608 1:4,263 1:2,218 1:3,217
I
Downloaded by [Temple University Libraries] at 22:31 20 November 2014
School Commuter Mixed Residential Services Basic Intermediate Comprehensive Total
vide indirect subsidy in the form of free space, liability protection, and employment overhead costs. We could not characterize a “typical” student health service because of the great variability of size and scope of service. The ratios of visits per student enrolled and professional staffing to student population were closely correlated to two interdependent variables (comprehensiveness of services and living arrangements of students). Two-year colleges and smaller 4-year colleges with student populations that lived predominantly off campus and commuted to school tended to provide basic or intermediate services only and showed significantly lower visit rates and professional staffing ratios. Alternatively, the larger 4-year institutions where most students lived on campus (residential) and were therefore dependent on the institution for human services tended to provide more comprehensive services, had higher visit rates, and higher professional staffing needs. When developing healthcare programs, campus officials responsible for student health services must first determine the nature of their student population and the availability of health services outside the institution. Campuses with residential students must assume a greater role in providing such human support systems as health services. Thus, the percentage of students living
on campus would be the most important factor in determining the need for more comprehensive health services and the concurrent need for more professional staffing to serve the student population. NOTE
Send reprint requests to Robert C. Davidson, MD, MPH, Department of Family Practice, University of California, Davis Medical Center, Sacramento, CA 95817. REFERENCES 1. Patrick KP. Student health-Medical care within institutions of higher education. JAMA. 1988;260:3301-3305. 2. Digest of Education Statistics. Washington, DC: National Center for Education Statistics; 1988. 3 . Post Secondary Fall Enrollments in Colleges and Universities: Preliminary Results of Fall 1988 Survey. Washington, DC: National Center for Education Statistics; 1989. 4. The Master Plan Renewed-Unit, Equity, Quality, and Efficiency in California Post Secondary Education. Sacramento, CA: Commission for the Review of the Master Plan for Higher Education; 1987. 5. Data Abstract Series. Sacramento, CA: California Postsecondary Education Commission; October 1988. 6. Report on Enrollment Fall 1987. Sacramento, CA: California Community Colleges, Chancellor’s Office; July 1988.
The National AIDS Information Clearinghouse Now-one toll-free number for reference assistance and to order publications:
1-800-458-523 1 FAX: 1-301-738-6616 A service of the U.S. Department of Health and Human Services Public Health Service W Centers for Disease Control
134
JACH
Journal of American College Health Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/vach20
College Health Services in California a
a
Robert C. Davidson MD, MPH , John M. Chuck MD & Suzanne Snively MD
a
a
Department of Family Practice , University of California, Davis School of Medicine , Sacramento, California, USA Published online: 09 Jul 2010.
To cite this article: Robert C. Davidson MD, MPH , John M. Chuck MD & Suzanne Snively MD (1991) College Health Services in California, Journal of American College Health, 40:3, 131-134, DOI: 10.1080/07448481.1991.9936269 To link to this article: http://dx.doi.org/10.1080/07448481.1991.9936269
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http://www.tandfonline.com/page/termsand-conditions
College Health Services in California
Downloaded by [Temple University Libraries] at 22:31 20 November 2014
Robert C. Davidson, MD, MPH; John M. Chuck, MD; and Suzanne Snively, MD
Abstract. College health services are an underrecognized segment of California’s health delivery system. Higher education institutions in California vary in their arrangements for the provision of health services. Some of the smaller institutions provide nurse triage, first aid, and referral only, whereas other institutions provide %-hour-per-day/7-day-per-week comprehensive ambulatory and inpatient services. More than 200 fulltime equivalent physicians are employed in college health services in California. Patient profiles served by college health services targeted the traditional college student age range. Some institutions, however, have expanded their services to include nonstudent university employees and their dependents. Comparing numbers of outpatient visits and professional staffing requirements to student enrollment showed significant variability between institutions, depending upon the scope of services provided (basic, intermediate, comprehensive) and the type of student population (residential, commuter, mixed). Key Words. College health, scope of services, staffing issues
C
ollege health services are an underrecognized segment of our nation’s health system. Student health services in the 10 largest (by enrollment) public and the 10 largest private institutions in the country were described in a 1988 study by Patrick.’ National statistics show that there are more than 3,400 institutions of higher education in the United States. Enrollment in these institutions in 1988 totaled 12.8 million ~tudents.’.~The American College Health Association estimates that 1,500 of these institutions in some way provide health services for 10 million students. California has an extensive system of public higher education institutions, in line with a state Master Plan for Higher Education developed under the auspices of then University of California president Clark K ~ I TThe .~ state plan provides for three multicampus higher educaThk article comesfrom the Department of Family Practice, University of California, Davk School of Medicine, Sacramento, California. Robert C. Davidson k associate professor and chair; John M. Chuck k a staff physician at Kaker Medical Center in Fairfield, California, and, at the time of the study, was chief resident in family practice; and Suzanne Sniveb is clinical professor of internal medicine. Dr Snively was formerly director of student health services at California State University, Sacramento. VOL 40, NOVEMBER 1991
tion systems, including the 2-year California Community Colleges, the California State University, and the
University of California. In addition, California has 181 independent degree-granting private colleges and univer~ities.~ Together, these California institutions have an annual budget exceeding $15 billion, and an enrollment that in 1987 totaled 1,923,631.5*6 Many of these institutions provide health services to students and, in some cases, to staff and faculty. Information regarding this segment of our health delivery system is not well delineted, which prompted the authors to carry out this survey. METHOD
We sent a questionnaire to the directors of all identified student health centers (SHCs) in California (N = 159). The list was compiled from several directories of student health service organizations. It is possible that the survey may have missed some institutions that provide student health services but are not associated with any student health service organization. The survey requested information on (1) general characteristics of the educational institution; (2) types of health services provided; (3) profile of patients cared for in the SHC; and (4) professional staffing of the SHC. Following the initial mailing, a second mailing was sent to nonrespondents, and we made telephone contact with directors to urge cooperation. RESULTS
Of the 159 educational institutions surveyed, 117 (74%) responded. Although all institutions were identified from lists of student health organizations, only 92 of the 117 respondents reported that they were currently operating SHCs. These 92 institutions constituted the study PoPulation. The 25 institutions that reported operating no SHCs were all 2-Year COmmUnitY Colleges. The majority of institutions that did not respond to the survey were also 2-year community colleges. only3 institutions that were Cyear institutions with student to expect student health enrollment large centers did not respond. The response rate of institu131
COLLEGE HEALTH
TABLE 1 Student Population Size of California Institutions With Student Health Centers
< 2,000
Downloaded by [Temple University Libraries] at 22:31 20 November 2014
2,000-5,000 5,000-10,000 10,000-20,000 > 20,000 No response Total
2-year schools Yo n
4-year schools n Yo
n
Yo
2 4 12 19 10 4 51
6 8 9 8 9 1 41
8 12 21 27 19 5 92
9 13 23 29 21 5 100
4 8 23 37 20 8 100
15 19.5 22 19.5 22 2 100
Total
TABLE 2 Type of Student Population of California Student Health Centers
Residential Commuter Mixed No response Total
2-vear schools n Yo
4-year schools n Yo
3 41 5 2 51
13 13 14 1 41
6 80 10 4 100
tions expected to provide student health services was, therefore, much higher than the actual rate of 74%. The size of the student population at institutions providing health services varied from small (< 2,000) to 19 institutions with more than 20,000 students (Table 1). The terms university, college, and community college are sometimes self-designated and do not indicate size or types of programs offered. Therefore, for clarity, we divided respondent institutions into 2-year and 4-year institutions. The student populations were self-described by the institutions as predominantly residential (students living on or near campus), commuter, or mixed (Table 2). Four-year institutions showed a mix of all three types, but most 2-year schools had commuter students. The types of health services provided were categorized as basic, intermediate, or comprehensive. Basic was considered first aid only, intermediate services were defined as primary care with basic laboratory facilities, and comprehensive services included primary and specialty physician services,.X-ray and laboratory diagnostic services, in-house pharmacy, and in-house counseling services. The majority (54%) of the 4-year schools provided comprehensive services, whereas most (63%) 2-year schools provided basic services only (Table 3). Most institutions (82%) provided ambulatory services only, although 5 institutions had inpatient beds as part of the student health service, and an additional 4 provided inpatient services at another hospital. Most SHCs (75%) were open weekdays. Some of the larger 4-year 132
32 32 34 2 100
Total
n
Yo
16 54 19 3 92
17 59 21 3 100
institutions and all of those with inpatient beds provided 7-day-per-week/24-hour-per-day service. Four-year schools averaged 140 outpatient visits per day, and the 2-year schools averaged only 40 visits per day. Most (89%) visits to SHCs were by registered students, although at one institution, 60% of the visits were by nonstudents. The number of student visits to the SHC in relation to total student population of the institution varied widely from a low ratio of 0.08 visits per 1,OOO enrolled students per day (a 2-year community college with commuter students and only basic health services provided) to a high of 23.8 visits per 1,000 enrolled students (a 4-year residential university with comprehensive services). The number of student visits per day to the SHC in relation to campus student enrollment was closely correlated with the percentage of students living on campus (residential). The average of all institutions that listed their student population as predominantly residential was a visit rate of 11.9 visits per 1,OOO enrolled students per day. Institutions that described their student population as mixed residential/ commuter averaged 9.3 visits per 1,000 enrolled students per day; those that were commuter schools reported an average rate of 4.5 visits per 1,000 enrolled students per day. The age of students served at SHCs was, as expected, an average of 25.2 years. Two-year schools had a slightly older average student age (27.1 years) than 4-year schools (22.7 years) (Table 4). The youngest student served at a California SHC was 12 years old, and the JACH
CALIFORNIA HEALTH SERVICES
Downloaded by [Temple University Libraries] at 22:31 20 November 2014
TABLE 3 Types of Services Provided at California Student Health Centers 2-year schools n VO
4-year schools
n
Vo
n
VO
Basic Intermediate Comprehensive No response Total
32 12 3 4 51
63 23 6 8 100
10 7 22 2 41
24
42 19 25 6 92
46
17 54 5 100
21 27 6 100
Ambulatory only On-campus inpatient Off-campus inpatient No response Total
46
90
29 5 4 3 41
71 12 10 7 100
75 5 4 8 92
82 5 4 9 100
1 26 9 3 2 41
2.5 63.5 22 7 5 100
6 69 9 6 2 92
6.5 75 10 6.5 2 100
Part-time weekdays Weekdays 7 days124 hrs Other No response Total
-
-
5
5 100
51
10 84
5
43 3
-
-
-
51
100
6
Total
TABLE 4 Age of Population Served at California Student Health Centers 2-year schools
4-year schools
Total ~
Age-student visits M Mdn Range Age-nonstudent visits M Mdn
27.1 27.0 19.0-35.0
22.7 22.5 19.0-30.0
25.2 25.0 19.0-35.0
40.3 40.0
38.6 40.0
40.0
oldest student was 90 years old. The average age of nonstudents served at the California SHCs was 39.6 years. This population comprised faculty and staff at the institution. Some institutions provided dependent care, but most provided nonstudent services only to employees of the institution. The professional staffing of California SHCs was quite varied, with combinations of full- and part-time physicians, nurse practitioners, physician assistants, and nurses. The average institution had a staff of 2.4 physicians, 1.3 nurse practitioners, 0.1 physician assistants, and 2.7 registered nurses. When all institutions were combined, the physician staffing average was 1 physician per 5,311 enrolled students. In addition, the average institution had a staffing of 1 nonphysician health provider per 3,217 enrolled students. Other health providers in this study included only nurse practitioners, physician assistants, and registered nurses. We found a marked variation in professional staffing, depending upon the type of service offered and living arrangements VOL 40, NOVEMBER 1991
~ ~ _ _ _ _
39.6
of the students. The ratio of physician and other health providers to student enrollment in relation to these variables is shown in Table 5. The total full-time equivalent (FTE) number of phyicians employed in California student health centers was 215.5. In addition, 113.7 FTE nurse practitioners, 6.0 FTE physician assistants, and 235.7 registered nurses work in California SHCs. DISCUSSION Health services provided by California institutions of higher education are often an unrecognized segment of the state health system. Reliable data regarding the overall cost of California SHCs could not be obtained in this study. Income for SHCs comes from a combination of student health fees and billing for services provided, either directly to the client as a co-payer or to the client’s insurance. Many students are covered under the health insurance policy of their parents. Most institutions do not provide direct dollar support to SHCs except through student fees. Many institutions, however, pro133
COLLEGE HEALTH
TABLE 5 Full-Time Equivalent (FTE) Professionals to Student Enrollment, by Type of Student Housing Arrangement and Scope of Services Offered
I FTE physician: Student population
FTE other health provider: Student population
123,517 1:3,444 1:2,098
1:4,676 1:2,104 1:1,454
1:22,297 1:9,545 1:2,940 15,311
1:5,608 1:4,263 1:2,218 1:3,217
I
Downloaded by [Temple University Libraries] at 22:31 20 November 2014
School Commuter Mixed Residential Services Basic Intermediate Comprehensive Total
vide indirect subsidy in the form of free space, liability protection, and employment overhead costs. We could not characterize a “typical” student health service because of the great variability of size and scope of service. The ratios of visits per student enrolled and professional staffing to student population were closely correlated to two interdependent variables (comprehensiveness of services and living arrangements of students). Two-year colleges and smaller 4-year colleges with student populations that lived predominantly off campus and commuted to school tended to provide basic or intermediate services only and showed significantly lower visit rates and professional staffing ratios. Alternatively, the larger 4-year institutions where most students lived on campus (residential) and were therefore dependent on the institution for human services tended to provide more comprehensive services, had higher visit rates, and higher professional staffing needs. When developing healthcare programs, campus officials responsible for student health services must first determine the nature of their student population and the availability of health services outside the institution. Campuses with residential students must assume a greater role in providing such human support systems as health services. Thus, the percentage of students living
on campus would be the most important factor in determining the need for more comprehensive health services and the concurrent need for more professional staffing to serve the student population. NOTE
Send reprint requests to Robert C. Davidson, MD, MPH, Department of Family Practice, University of California, Davis Medical Center, Sacramento, CA 95817. REFERENCES 1. Patrick KP. Student health-Medical care within institutions of higher education. JAMA. 1988;260:3301-3305. 2. Digest of Education Statistics. Washington, DC: National Center for Education Statistics; 1988. 3 . Post Secondary Fall Enrollments in Colleges and Universities: Preliminary Results of Fall 1988 Survey. Washington, DC: National Center for Education Statistics; 1989. 4. The Master Plan Renewed-Unit, Equity, Quality, and Efficiency in California Post Secondary Education. Sacramento, CA: Commission for the Review of the Master Plan for Higher Education; 1987. 5. Data Abstract Series. Sacramento, CA: California Postsecondary Education Commission; October 1988. 6. Report on Enrollment Fall 1987. Sacramento, CA: California Community Colleges, Chancellor’s Office; July 1988.
The National AIDS Information Clearinghouse Now-one toll-free number for reference assistance and to order publications:
1-800-458-523 1 FAX: 1-301-738-6616 A service of the U.S. Department of Health and Human Services Public Health Service W Centers for Disease Control
134
JACH
