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Original Investigation |

Cost-Benefit Study of School Nursing Services

Li Yan Wang, MBA, MA1; Mary Vernon-Smiley, MD, MPH1; Mary Ann Gapinski, MSN, RN, NCSN2; Marie Desisto, RN, MSN3; Erin Maughan, PhD, MS, RN, APHN-BC4; Anne Sheetz, MPH, RN, NEA-BC2
[+] Author Affiliations
1Division of Adolescent and School Health, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
2Office of School Health Services, Division of Primary Care and Health Access, Massachusetts Department of Public Health, Boston
3Waltham Public Schools, Newton, Massachusetts
4National Association of School Nurses, Silver Spring, Maryland
JAMA Pediatr. 2014;168(7):642-648. doi:10.1001/jamapediatrics.2013.5441.
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Importance  In recent years, across the United States, many school districts have cut on-site delivery of health services by eliminating or reducing services provided by qualified school nurses. Providing cost-benefit information will help policy makers and decision makers better understand the value of school nursing services.

Objective  To conduct a case study of the Massachusetts Essential School Health Services (ESHS) program to demonstrate the cost-benefit of school health services delivered by full-time registered nurses.

Design, Setting, and Participants  Standard cost-benefit analysis methods were used to estimate the costs and benefits of the ESHS program compared with a scenario involving no school nursing service. Data from the ESHS program report and other published studies were used. A total of 477 163 students in 933 Massachusetts ESHS schools in 78 school districts received school health services during the 2009-2010 school year.

Interventions  School health services provided by full-time registered nurses.

Main Outcomes and Measures  Costs of nurse staffing and medical supplies incurred by 78 ESHS districts during the 2009-2010 school year were measured as program costs. Program benefits were measured as savings in medical procedure costs, teachers’ productivity loss costs associated with addressing student health issues, and parents’ productivity loss costs associated with student early dismissal and medication administration. Net benefits and benefit-cost ratio were calculated. All costs and benefits were in 2009 US dollars.

Results  During the 2009-2010 school year, at a cost of $79.0 million, the ESHS program prevented an estimated $20.0 million in medical care costs, $28.1 million in parents’ productivity loss, and $129.1 million in teachers’ productivity loss. As a result, the program generated a net benefit of $98.2 million to society. For every dollar invested in the program, society would gain $2.20. Eighty-nine percent of simulation trials resulted in a net benefit.

Conclusions and Relevance  The results of this study demonstrated that school nursing services provided in the Massachusetts ESHS schools were a cost-beneficial investment of public money, warranting careful consideration by policy makers and decision makers when resource allocation decisions are made about school nursing positions.

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