School districts in America are facing turbulent times.
State funding sources are more limited. Local property values are going down
along with tax receipts. Schools could likely make the adjustments for
recession if recession were the only budgetary difficulty, but they also face the
more serious, accelerating problem of health care cost increases.
As 70 – 80% of school expenditures cover personnel, school district budget officers have little
choice but to freeze employee salaries or employ fewer teachers if they hope to meet health costs. It seems that school districts have been forced to choose between employee
benefits and their primary task of education. Meanwhile, children in U.S. schools are falling behind their peers in other nations, just as they are falling behind in terms of overall well being.
But at least one school district in America — Kirksville R(eorganized) III, in Kirksville, Missouri — has managed to maintain the same health care premiums for the past five years.
This district even reduced health care premiums for
its staff and employees in tortuous 2009. Kirksville R-III faces the
same challenges as other districts do, but it has made a different set of choices.
Rather than favoring the short term or insurance companies, the
district has focussed on health care for employees – a rather novel
One way the district has tried to encourage its employees to
be cost conscious is by reimbursing them 100% for their first $500 of
health care expenses. Employees can choose to spend this $500 on
costly emergency care, or they can tend to many of their families’ routine and preventive
care needs. The less costly choice is incented.
One distinguishing feature of health care in rural areas is that
primary care givers dominate the medical workforce. When employer health
plans support primary care, they are supporting local health care
and local economics. In general, employee health plans that offer first-dollar coverage or coverage of annual
screening visits support primary care
The Kirksville R-III school district has paid for health fairs
and screenings to help determine if employees have hypertension, diabetes, or other “risky” conditions. Routine screenings involving breast and colon
cancer are also emphasized; early identification and treatment can go a long
way toward preventing poor health and costly health care.
When was the last time your employer gave your family a
Christmas gift that kept on giving? Three Decembers in a row, 2006-2008, the families
connected to Kirksville R-III received a health care premium holiday: they paid no premiums.
When employees save on costs, employer health plans can afford to be
appreciative. In turn, these special benefits encourage full participation in the design.
Optimal health care delivery requires coordination of patients, health care providers, insurers, and employers. The
current dysfunction all too common in U.S. health care can allow other interests
to creep in that are not focused on health-care delivery. Employers are in a
unique position to coordinate the essential elements, to integrate community needs for local health services, keep
precious dollars at home, and save costs for employees and the community.
Financing schools systems, local government, and health care
typically comprises an enormous share of small town economies. The choices
made locally shape jobs, business, services, and the quality of life. The impact is
illustrated by the “Rural Medical Miracle” in Summersville, West Virginia,
and by the Kirksville R-III school district.
Coordination benefits the entire area. When school districts
and employees must pay more for health care, sacrifices in education follow.
There is less funding to hire the best teachers or even enough teachers. As health care costs increase, rural school districts face the prospect of flat or declining salaries, increasing health premiums, and higher out of pocket costs. Schools that manage health care costs are better able to recruit good teachers and retain them.
The same principles apply for
rural health systems. Those that manage costs well are in a
better position to recruit, support, and retain health care pros. Health care plans can be coordinated to support local
health care, keeping dollars at home. When more local
dollars are freed up from health care costs, those funds can benefit families
It is possible to
coordinate health care or education in ways that optimize outcomes for minimal cost. Rural people have learned to focus on the elements that matter the most. By tending to the health care needs of community members that happen to be employees, small towns — and rural school districts, especially — can do much more. This kind of restructuring is the pathway to national recovery in
economics, health, and education.
Neal Chamberlain, Ph.D., a member of the Kirksville R-III
school board for more than 12 years, is a faculty
member at A.T. Still College of Osteopathic Medicine, Kirksville, Missouri.
Robert C. Bowman, M.D., has a 26 year career involving health access and
is a professor at A.T. Still School of Osteopathic Medicine in Mesa, Arizona.