Linking Improvements in Health-Related Quality of Life to Reductions in Medicaid Costs Among Students Who Use School-Based Health Centers

Abstract

We examined whether improvements in pediatric health-related quality of life (HRQOL) stemming from use of school-based health centers (SBHCs) resulted in lower Medicaid costs. We analyzed data on 290 students from a 3-year, longitudinal SBHC evaluation conducted in Cincinnati, Ohio, in 2000 to 2003, including 71 with a mental health diagnosis and 31 with asthma, who had linked Ohio Medicaid records. HRQOL was measured using the Pediatric Quality of Life Inventory. Panel regression examined whether changes in parent-reported and student self-reported HRQOL predicted changes in Medicaid costs. After adjustment for gender, age, SBHC status, and Medicaid type, we found cost reductions for every 1-point increase of parent-reported total ($36.39; P<.01), physical ($35.36; P<.05), and psychosocial ($25.94; P<.01) HRQOL. Significant cost reductions were also associated with student-reported total ($8.94; P<.05) and psychosocial ($7.79; P<.05) HRQOL increases. These effects were significant among the asthma subgroup but not the mental health subgroup. Physical HRQOL ($6.12; P=.27) effects were not significant. Improvements in pediatric HRQOL translate into lower Medicaid costs, supporting the use of HRQOL as an outcome for evaluating SBHCs.