Relative Frequency of Health Problems in Low-Income Children Compared with Other Children

It is estimated that as many as 12 million children under the age of 18 have no health insurance, or approximately 17 percent of all children in that population (American Medical Association Council on Scientific Affairs, 1990). Millions more have inadequate plans that fail to cover even basic preventive services, such as immunizations (National Health Education Consortium, 1992). Although progress has been made in establishing publicly financed community health centers in inner cities and rural areas, school-age youth rarely visit these facilities until their health problems reach crisis stage. Although Medicaid is intended to provide services for poor children, variations in state Medicaid policies have left almost 40 percent of children who live in poverty without access to basic primary and preventive care (Solloway and Budetti, 1995). Possible changes in the system imply even greater uncertainty about the role Medicaid will play in providing universal coverage for poor children and adolescents (Newacheck et al., 1995).

Absenteeism among students is clearly associated with school failure (Wolfe, 1985). Research has shown that students who miss more than 10 days of school in a 90-day semester have trouble remaining at their grade level (Klerman, 1988). In particular, children who are poor are two to three times more likely to miss school due to their illnesses (Starfield, 1982). Indeed, children with health problems are disproportionately poor students on the verge of academic failure. Youth frequently must miss valuable class time in order to get care for their illnesses during the regular office hours of public and private health professionals. In fact, a recent study found that students utilizing public clinics missed entire days of school per appointment (Kornguth, 1990). Thus, "health-related risk factors often set in motion a cycle of absenteeism and school failure" (Lewis and Lewis, 1990). Studies have also found that people living in poverty are twice as likely to have mental health problems; hence, low-income children are especially affected by the absence of accessible mental health care (Starfield, 1982).

Given these findings, it appears that the lack of accessible primary care has a high cost, in terms of both health and education outcomes. Providing primary care to needy students at the school site has been proposed to be efficient and cost-effective in the long run, in order to improve academic performance and detect health problems early before they require more expensive treatment. Then the difficult question naturally follows: Would all students, not only those in poverty, benefit from availability of convenient, accessible basic primary care services at school, provided by professionals specially trained to deal with their age level? In



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