Kirksville R-III Geometry teacher Kim Belanger at Kirksville High School, one beneficiary of the school district's new approach to health care.
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 approach.
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.
Neal Chamberlain Kirksville High School
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.
Kirksville-RIII Geometry students at Kirksville High School. The district's board has found a way to hold teacher and staff insurance premiums steady through a down economy.
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 and communities.
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.