1. The addition of school health services to standard benefit packages —under this option, both public and private insurance benefit packages would designate school health services as "covered services." The insurers themselves would not directly reimburse those who provide the services but would send the reimbursement to a fund set up for school health services. This option amounts to making school health services a "mandated benefit" for all health coverage. It is estimated that establishing the cost of this new benefit at 1 percent of premiums would raise nearly $9 billion. This approach would also spread the cost broadly; in addition, establishing school health services as a covered service should help insulate it from the uncertainties of the political and administrative processes. Disadvantages of this approach include the cost shift problem of option 1. In addition, if "school health'' coverage were a fixed dollar amount, the approach would be regressive, consuming a greater proportion of the premium of a low-cost plan.

  2. Excise taxes and penalties on products or processes that affect health might include taxes on alcohol and tobacco products, gasoline, and ammunition, as well as penalties on polluters. An advantage to this approach is that it accomplishes two goals—financing school services and discouraging the use of products and practices linked to health problems. A limitation of this approach is that the revenue base will shrink if the tax is successful in reducing consumption. In addition, excise taxes are not as broad and progressive as the system-wide health contribution described in options 1 and 2.

FIRST STEPS FOR A COMMUNITY IN ESTABLISHING SCHOOL SERVICES

In this section, the committee uses the American Academy of Pediatric's seven "goals" for school health programs, listed at the beginning of this chapter and repeated below, to organize the discussion of specific questions and actions that a community might consider in establishing an appropriate set of school health services within a comprehensive school health program.

Goal 1

Ensure access to primary health care.

Goal 2

Provide a system for dealing with crisis medical situations.

Goal 3

Provide mandated screening and immunization monitoring.

Goal 4

Provide systems for identification and solution of students' health and educational problems.

Goal 5

Provide comprehensive and appropriate health education.

Goal 6

Provide a healthful and safe school environment that facilitates learning.



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