Assessment of school-based health centers in a rural state: the West Virginia experience.
OBJECTIVE
To assess the capability of school-based health centers (SBHCs) to provide access to health care for rural youth.


METHODS
Review of annual patient records from SBHCs in West Virginia. Ten of 24 SBHCs in West Virginia in operation from July 1994 to June 1997 were selected for the study. Enrollment and utilization rates were generated for each site. A comparison was made between rates of enrollment, utilization, and annual visits among youth with private insurance, those covered by Medicaid, and youth without insurance. Rural and urban SBHCs within West Virginia were compared based on enrollment, utilization, and visit rates. The diagnostic categories were analyzed. Finally, enrollment rates, utilization rates, and insurance status for the West Virginia SBHCs were compared with national norms.


RESULTS
Enrollment rates rose steadily during the study period from 27% in Year 1 to 64% by the end of Year 3. The utilization rate was 67% in Year 3. The youth with either Medicaid or no insurance comprised 52% of enrollees, but they accounted for 63% of all visits. West Virginia SBHCs have a higher rate of Medicaid users than the national average for SBHCs, and the annual visit rate for West Virginia youth is higher than the national average for nonmetropolitan adolescents. The enrollment rate of 64% is slightly higher than the national average for SBHCs. Within West Virginia, the enrollment rate in rural schools was significantly higher, 86% compared to 46% (p < .001), and the utilization rate was 70% in rural centers compared to 63% in the urban centers (p < .001).


CONCLUSIONS
When SBHCs are available in rural areas, students use them. In West Virginia, SBHCs have contributed to providing access to health care for rural youth.
Crespo
R D
RD
Department of Family and Community Health, Marshall University School of Medicine, Huntington, West Virginia, USA.
Shaler
G A
GA
D000293:Adolescent; D016497:Adolescent Health Services / Q000706:statistics & numerical data* / Q000639:trends; D003151:Community Health Centers / Q000706:statistics & numerical data* / Q000639:trends; D003953:Diagnosis-Related Groups / Q000706:statistics & numerical data; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006302:Health Services Research; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data; D008484:Medicaid / Q000706:statistics & numerical data; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D015397:Program Evaluation; D019035:Rural Health Services / Q000706:statistics & numerical data* / Q000639:trends; D012572:School Health Services / Q000706:statistics & numerical data* / Q000639:trends; D014481:United States; D019037:Urban Health Services / Q000706:statistics & numerical data / Q000639:trends; D014903:West Virginia