Special Edition: College Health Programs

This month, 16.9 million kids will begin their college career joining 3 million seeking graduate degrees. Most will be full time students (62%) and three in four will be over the age of 25.

It’s an ethnically diverse population: 52% are Caucasian, 20% are Hispanic, 17% are African American, 6% are Asian, 1% are native American and a mix of internationals comprise the rest.

In Campaign 2020, healthcare services for college students has gotten scant attention. A pledge to forgive (Warren, Sanders) or reduce (Delaney, Gillibrand, O’Rourke) the burgeoning $1.5 student loan has been the major focus. Funding for student health services, insurance coverage for and the quality of healthcare services accessible is not on the political radar.

But for college administrators, parents and guardians, and the students themselves, student health services play a vital role that’s often taken for granted. Consider:

Student health is clinically complex: Four of five college students describe their health as excellent or good but one in four has a medical condition (diabetes, asthma et al) requiring regular attention and half experience mood and anxiety symptoms while in school. (See College Student Health Status in Fact File). Student health providers treat physical, emotional and social needs of students and specialty care services in tandem. Interdisciplinary teams deliver primary and specialized care through clinical models that leverage medications, over-the-counter therapies, counseling, social services and more. As Lipscomb Director of University Health Services Erin Keckley, DNP, APRN, FNP-C advises: “Food is the most common used anti-depressant. Exercise is the most common unused anti-depressant.”

Student health programs are operationally unique: College health programs operate 7 days per week, 24 hours daily. They advise campus food services about unique student nutritional requirements, coordinate transportation services for students needing specialized care administrators in developing healthy campus policies and procedures. They interact with local providers, hospital emergency rooms and with clinicians at home who treat students in tandem. They maintain Joint Commission/AAAHC credentials while complying with state and federal rules about privacy, safety and quality. And fewer than one in four uses an electronic record system with which to coordinate care.

Student health is under-funded: According to the American College Health Association, the majority (55%) of college student health programs depend on a combination of institutional appropriations plus fee for service payments from students to make ends meet. Some students have private insurance, but services provided in student health clinics are not billed to insurers. Most are understaffed and under-funded by their schools at a time when the complexity of care needed for students intensifies. In the last two years, 48% have not seen an increase in their appropriations from their institutions while facing higher labor and supply costs.

It’s in this context that college student health programs operate. Like the healthcare industry overall, there’s is a unique challenge.

MY TAKE

While attention to healthcare takes center stage in Campaign 2020, perhaps state and federal policymakers and candidates, university officials and parents should take a closer look at college health.

It is the frontline for innovation in preventive and primary care at a time when good and bad habits are formed that impact a student’s health for life. Student health programs on America’s college campuses serve a large, influential and diverse population: that’s the environment to which the entire healthcare industry must increasingly adapt.

Student health on college campuses is not as sexy as college football but arguably it’s more important.

Paul






FACT FILE: COLLEGE HEALTH

College Enrollment: down 1.8% in 2018-2019—8th consecutive year decrease.

Community colleges -3.4%, Four-year public institutions - 0.9%, Four-year private institutions + 3.2%. for-profit four-year colleges -19.7%. (primarily due to the conversion of private, for-profit to nonprofit status i.e. Grand Canyon University). Between 2000 and 2017, total undergraduate enrollment in degree-granting postsecondary institutions increased by 27% (from 13.2 million to 16.8 million students). Of the 17 million undergraduates, 27% are over the age of 24 and 21% dropped out of college before earning a degree. Student demand for elite institutions (US News and World Report Top 50 Colleges & Universities) will be 14% higher in 2029 than it in 2012 vs. 11% lower for four-year institutions which serve local students are expected to lose more than 11% of their students. By 2028, total undergraduate enrollment is projected to increase to 17.2 million students—essentially flat growth. National Student Clearinghouse Research Center, National Center for Education Statistics

College Student Health Status: 82.0% of college students (84.8 % male and 81.2 % female) describe their health as good, very good or excellent.

52.1 % (42.6 % male, 59.9 % female) reported being diagnosed or treated by a professional with one or more of these conditions in the last 12 months: Allergies: 21.0 %, Hepatitis B or C: 0.3 %, Asthma: 8.9 %, High blood pressure: 3.1 %, Back pain: 11.9 %, High cholesterol: 3.1 %, Broken bone/Fracture/Sprain: 6.0 %, HIV infection: 0.2 %, Bronchitis: 5.3 %, Irritable Bowel Syndrome: 3.4 %, Chlamydia: 1.5 %, Migraine headache: 9.2 %, Diabetes: 1.1 %, Mononucleosis: 1.3 %, Ear infection: 6.5 %, Pelvic Inflammatory Disease: 0.3 %, Endometriosis: 1.0 %, Repetitive stress injury: 1.8 %, Genital herpes: 0.7 %, Sinus infection: 16.4 %, Genital warts/HPV: 0.8 %, Strep throat: 9.9 %, Gonorrhea: 0.5 %, Tuberculosis: 0.3 %, Urinary tract infection: 9.5 %.

The prevalence of conditions in college health population: Attention Deficit and Hyperactivity Disorder (ADHD) 8.2 %, Chronic illness (e.g., cancer, diabetes, auto-immune disorders) 5.8 %, Deafness/Hearing loss 1.8 %, Learning disability 4.4 %, Mobility/Dexterity disability 1.0 %, Partial sightedness/Blindness 2.6 %, Psychiatric condition 9.3 %, Speech or language disorder 1.0 %, Other disability 2.7 %. American College Health Association

Sources of Funding for College Health Programs: Student fees only-24%, university general funds 10%, student fees + fee for service payments- 55%; 48% reported no increase in funding in the last 2 years. American College Health Association

Information Technologies used in College Health Programs: Medicat, Point and Click Solutions, PyraMED, Epic, eClinical Works, Neusoft American College Health Association