Across the country, student health centers are showing signs of financial bloat and costly mission creep. Funded by both hefty campus health fees and payments from students' insurers, university health centers spend their extra cash on boutique services and progressive programs.
In universities' early days, the campus infirmary was simple. As a primary care practice on campus, it was a convenience for students who caught the flu or a cold at school. The infirmary's services were available to insured and uninsured alike. Now, however, all students must carry health insurance. Many schools, including the 16 campuses of the University of North Carolina system, put in place an "individual mandate" years before the Affordable Care Act. With the Act's passage, all students must be insured.
And they are - often with "Gold" plans that cover everything from maternity care, to prescription drugs, to substance abuse counseling. If they use the student health center, students' co-pays are waived. But at many schools, they pay through the nose for the privilege. Saving $25 in co-pays hardly seems to justify paying health fees ranging from $50 to nearly $1,000.
Harvard and Stanford are two of the worst offenders. At Harvard, the student health fee is $958.00. Health insurance, which students must also purchase, is $2,190. At Stanford, the fee is a more modest $573 for the 2014-15 academic year. But the student health insurance plan costs a whopping $3,936 per student!
At schools across the country, fees range widely. The fee is $40.00 at Arizona State University, $175 at the University of Kentucky, $150.00 per year at Oklahoma State, $69.86 at UC Boulder, and $170 at Pitt. At the University of Florida, the health fee is $14.11 per credit hour, or roughly $423 per year. Florida State's fee is close behind, at $13.97 per credit hour or $419 per year.
The fee is $820 at UNC School of the Arts - allegedly to cover performance injuries. At UCLA, the health fee is obscured as part of the "student services fee" of $972. Health insurance at most schools falls in the range of $800 to $1,500 per year.
But even schools with modest fees end up with millions in funding for student "health care." It's unclear what students are getting for their money.
In many cases, fees and insurance seem to overlap, paying twice for some services - like primary care and women's health visits. For example, UNC-Chapel Hill's Campus Health Services website reports that students' annual fees support "unlimited provider visits in the Primary Care Clinics," while a list of students' insurance benefits includes "100% coverage for Preventive care at Student Health Center and in-network providers."
At other schools, the fee seems to cover very few health services, leaving either insurance or out-of pocket fees to fill the gap. At UF, the fee is "paid as part of tuition that goes to many campus-wide health initiatives" of which health center office visits are only a part. In fact, "procedures, X-rays, lab tests, medical equipment, prescriptions, non-prescription medications, and vaccinations" are not covered by the fee.
And in any case most "young invincibles" rarely go to the doctor. That's why they're so valuable as sign-ups in the Affordable Care marketplace. If not doctor visits, then what are students' health fees actually paying for?
At many student health centers, fees go to promote progressive causes, including social justice, diversity, and an "anything goes" attitude towards sex. Many of the services offered are only tangentially related to student health.
At UF, the fee funds the Counseling and Wellness Center, a division of student affairs whose work includes outreach on diversity issues, social justice, and international initiatives. One of the center's initiatives is "Que Pasa," a workshop series that "allows students to reflect on issues that matter to them." The center also provides diversity presentations on "Multicultural Expressions of Spirituality," "To Be or Not To Be...Out in the Workplace?" and "Constructing Race and Ethnicity in the 21st Century." This semester, the center is hosting workshops on the "Do's and Don'ts of Getting Over a Breakup," reducing test anxiety, and building social confidence.
At Harvard, the $958.00 health fee funds a range of health services from allergy treatment to ultrasounds. Students who pay the fee have access to discounted rates on massage and acupuncture through the Center for Wellness. The Center also provides "wellness proctors" for each dorm, sponsors a farmer's market, and hosts an online "virtual relaxation room" and workshops on aromatherapy, meditation, and knitting.
At UNC-Chapel Hill, as I noted here, the campus fee has drawn criticism from the Board of Governors. The Carolina health center employs seven primary care doctors, four psychiatrists, eight psychologists, six social workers, 11 athletic trainers, and dozens of additional doctors, nurses, and staff. Students have access to walk-in therapy sessions, nutrition counseling, tailored nutrition plans from registered dietitians, and access to "sexperts" who provide sex health counseling.
The fee has also paid for staffers for a theatre group that "uses scripted and improvisational performances to promote discussions about health, wellness and social justice." The fee also covers the salary of a "strategic planner for diversity initiatives," and it helped sponsor "Orgasm? Yes, Please!" a campus event that provides a "fun, educational look at sexual health, relationships, and pleasure!"
At UCLA, the health center's homepage boasts of "free yoga for young people with irritable bowel syndrome!" And the campus MindBody Clinic provides acupuncture and massage services "to unwind from the daily stresses of being a college student." UCLA's student insurance plan, UCSHIP, is especially generous: it covers hormone therapy and gender reassignment for UCLA students. And no expense was spared building the Ashe Student Health and Wellness Center; the center's website notes that "gender inclusive bathrooms are located on every floor of The Ashe Center for your convenience."
The Vaden Health Center at Stanford will treat anything from loneliness to alcohol abuse. It also offers "health promotion services" including body image consultations and a semester-long course on happiness. Stanford also hosts a sexual health peer resource center, which provides undergraduate students with "$3 worth of free products each quarter. This can be applied to any of our products including condoms, lube, female condoms, pregnancy tests, and toys."
At a time when tuition and fees have been increasing faster than the rate of inflation, it's important for students and parents to get the most bang for their healthcare buck. At many schools across the country, that's not happening. It's time for these "health centers" to get a serious check-up.
Jenna Ashley Robinson is the director of outreach at the John W. Pope Center for Higher Education Policy. This article originally appeared in Minding the Campus.
Read more at Minding the Campus:
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White House Joins War on Men
Why Do Most College Students Think the Same Thoughts