School-Based Health and Healthcare Utilization Among Rural Youth: Evidence from a School-Based Health Center Opening.

Abstract

To examine the effects of opening a school-based health center on primary and preventive care utilization among students in a rural setting. This quasi-experimental study used patient-level electronic health records data from a healthcare network serving a rural region of New York. The sample included patients aged 5-18 residing in 1 school district that opened a school-based health center and those who resided in similar districts without a center, spanning 2.5 years before and 2.5 years after the new center opened. The number of primary care visits and occurrence of any well-child, immunization, and convenient care visits were studied. Difference-in-differences event study models were used to estimate post-intervention changes in utilization trends adjusting for age, sex, treatment district, and half-year fixed effects. Multivariable estimates demonstrated increases in primary care visits and increased odds of receiving an immunization among patients in the treatment group vs those in comparison groups, after the school-based health center opened. These data provide robust associations consistent with causal evidence that school-based health centers increase utilization of primary care and expand access to a usual source of care in rural settings, highlighting the value of expanding school-based care in these communities.