Does Opening School-Based Health Centers Reduce ER Visits? Evidence from New York State

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Abstract

This study examines the impact of School-Based Health Centers (SBHC) openings on emergency room (ER) visits among school-aged children. It further investigates how effects vary by the type of lead sponsoring organization, reflecting different forms of cross-sector collaboration (public–public, public–nonprofit, and public–private).
   Improving access to healthcare for disadvantaged children remains a central policy challenge in the United States, with implications for both health and educational outcomes. Barriers such as limited insurance coverage and inadequate provider availability often lead children from low-income families to rely on emergency visits for conditions that could be managed through primary care. SBHCs have emerged as a widely adopted policy intervention designed to address these gaps by delivering accessible, school-linked healthcare services. Despite their rapid expansion, there is limited causal evidence on whether SBHC openings reduce emergency care utilization and whether outcomes differ across types of cross-sector collaborations.
    The paper asks two questions. First, do SBHC openings reduce ER visits for preventable physical and mental health conditions among school-aged children? Second, does the effectiveness of SBHCs depend on the type of cross-sector collaboration, as reflected in differences among lead sponsoring organizations? The analysis uses a school district-year level panel from 2011 to 2021 in New York State. It includes 1) the National Census of School-Based Health Centers, which contains information on SBHC locations, opening years, and sponsor types, 2) Statewide Planning and Research Cooperative System (SPARCS), which provides comprehensive claims data on inpatient and outpatient hospital visits, and 3) administrative datasets from the New York Department of Education. These data are linked by using a geo-matching approach at the Zip code level. 
    This study employs a staggered difference-in-differences (DID) design that uses variation in the timing of SBHC entry across school districts. The identification strategy compares changes in ER visits before and after SBHC openings in treated areas relative to comparable control areas that do not experience an opening in the same period. It also includes school district fixed effects to account for time-invariant unobserved heterogeneity and year fixed effects to capture common shocks affecting all districts. A key empirical challenge is that the SBHC openings are not random, as they often depend on local demand, institutional capacity, and partnerships between schools and healthcare providers. To address this selection concern, the analysis incorporates a propensity score matching (PSM) approach to construct a control group of school districts that are observationally similar to treated districts prior to SBHC entry. Specifically, districts are matched based on pre-treatment characteristics, including student socioeconomic characteristics, racial composition, and enrollment. This matching procedure ensures that treated and control districts have similar baseline trends and likelihoods of receiving an SBHC.
   This study expects SBHC openings to reduce ER visits for chronic physical conditions and mental health problems, particularly in underserved communities. The effects may be more heterogeneous, given variation in service provision and capacity across SBHCs. Furthermore, the magnitude of these effects is expected to differ by sponsor type, reflecting differences in resources and organizational capacity.

Author

• Miyeun Jung, University at Albany
  Presenting Author