Managed Health Care and School Health

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Abstract
The articles prior to January 2008 are part of the back file collection and are not available with a current paid subscription. To access the article, you may purchase it or purchase the complete back file collection here Howard L Taras, MD, FAAP There are a number of rapid changes occuning in the nation's health care systems that may have a serendipitous effect on the relationship doctors have wirh schools. One of these is the trend for a majority of children to be insured through a managed care insurance program. In most parts of the nation, this occurs both for those insured rhrough private, commercial plans and for children eligible for Medicaid and other publicly funded programs. A trend is that private practices are linked to larger networks of physicians. This is often in the form of large medical groups, but may also be through looser associations. This is very good news for schools. Interactions between school health staff and physicians have traditionally been limited to communication surrounding individual students. More broadly based interactions between the health sector and schools would have been too cumbersome because school districts would have had to interact with anywhere from dozens to thousands of doctors. However, the clustering of physicians into umbrella organizations, whether rhrough MCOs or medical groups, allows schools an opportunity to reach many health professionals wirh far less effort. This window of opportunity to facilitate interaction is also an opportunity to improving children's health. Preventive care, health education, compliance with medication, and history taking beyond the parent's input, are examples of time-consuming practices that physicians have been grappling with for a long time. Now there may be a "partner" for the medical profession. Schools may help us address some of modern medicine's greatest challenges. Naturally, this poses many questions: What's in it for the schools? Should schools be in the health care business? Is this partnership going to cost doctors money? How would a doctor or a medical group begin to set up this sort of relationship? How do managed care organizations fit in? What specific interactions with schools can occur? What services are there for patients? It may take the next decade before these questions can be fully answered. Nevertheless, collaborative projects between schools and the health sector have been sprouting up in numerous parts of the nation. Moreover, they are finding answers. THE PARTNERS IN SCHOOL HEALTH The Educational Sector The range of health services provided at schools varies widely between school districts and between schools within most districts. The level of enthusiasm with which school staffs engage in their students' health issues is also without uniformity. Neverthe-less, some generalizations can be made. Schools are mandated to perform basic health screens on all students at certain grade levels (vision and hearing, for example). All schools must make reasonable accommodations to include students with specialized health care needs.1 This often means G-tube feedings, administering medications, assisting students with diabetes control, and coping with seizures. Speech therapy, physical therapy, and occupational therapy are often necessary components of a child's educational plan. Schools usually require children to have a physical examination at first grade, and they all require students to be adequately immunized at school entry. Sports physicals are important at the secondary school level. These are "mandated" areas where rhe educational sector and health sector interface. Beyond that, many school staffs have come to realize that any child's good health( including those without special health needs) is an important ingrethent to his or her success in learning. They have noticed that if they help children with, asthma management, they are less likely to be absent from school for asthma.2 Children with significant famüy dysfunction, behavior problems, and risktaking concerns are more likely to attend to their school work if the school assists with early detection and referral for these problems. To health professionals this… 10.3928/0090-4481-19971201-12