The Cost of the Health Care Workforce in Schools

The Cost of the Health Care Workforce in Schools

At the end of every fiscal year, public schools are required to submit a financial report to the California Department of Education (CDE) where the data is shared with legislators and regulatory agencies. Similar to healthcare organizations, the education sector strives to provide a high-quality education while minimizing unnecessary costs. The passing of the Individuals with Disabilities Education Improvement Act (IDEA) has resulted in a significant number of students coming to school with various complex health conditions, impacting the cost of the current healthcare workforce needed in educational organizations.

Three Key Drivers of Labor Costs with School Nursing

Significant labor costs associated with school health services include the school nurse’s salary, fringe benefits, and medical supplies and equipment. The Orange County Department of Education (OCDE) is a civil service system where salaries are pre-determined by job classification. OCDE credentialed school nurses get paid on a seven-hour salary scale based on years of experience, degrees held, ranging from $60,489 to $131, 538 (Orange County Department of Education, 2017), and guaranteed for the contracted school year. Dessler (2015) states that health insurance coverage is a primary focus for most employees due to the cost associated with it. OCDE offers an HMO plan that is of no cost to the employee to cover themselves and their family members and a PPO plan that is of no cost to the employee but costs $70 a month per additional family member. School nurses and their families also have access to free vision and dental coverage. OCDE offers preventive incentives, paying $50 to employees for certain yearly screenings. OCDE school nurses are responsible for a multiplex of medical procedures. If deemed medically stable, every student has a right to a free and appropriate education making it a legal obligation for schools to meet student’s healthcare needs. Although parents are responsible for providing specific medical supplies and equipment, OCDE also has a responsibility to purchase medical resources to ensure a safe learning environment.

Educational Sector’s Solutions to Address School Health Labor Costs

OCDE's pay scale for school nurses is transparent, reflecting the cost of living and union negotiations. Controlling salary costs is challenging with unions and civil service systems because job classifications and deliberations determine pay. One solution to controlling salary spending is not replacing employees who retire or leave. OCDE must also discuss fringe benefit costs and expenditures with union representatives. Every year OCDE has looked at increasing its employee’s out of pocket expenses for healthcare coverage which has occurred but remains minimal related to union negotiations. School nursing services are paid for using educational funds and when cutbacks arise the school nurse’s role is commonly one of the first to be eliminated because few states mandate a school nurse for every school (Wang et al., 2014). OCDE utilizes the School-Based Medi-Cal Administrative Activities (SMAA) Program for school health services to receive payment for eligible services which is used to purchase medical supplies and equipment. Part of the SMAA process involves a reporting system that determines the amount of reimbursement OCDE will receive (California Department of Health Care Services, 2015).

Conclusion

School healthcare labor costs are often an under-valued component in education. Research illustrates that from a societal perspective, the benefits of school nursing services exceeds the labor costs affiliated with these resources (Wang et al., 2014). For educational and legislative stakeholders to appreciate school nursing labor costs and maximize funding, school nurses must commit to data collection, advocacy, and policy-making. Proponents of strengthening school health services need to reach the State Boards of Education, local school districts, and state legislators. Since school nursing falls under the public health umbrella, another solution involves reaching out to local health care agencies to gather funding to offset labor costs. Unless school nurses better illustrate the various vital functions they fulfill, I predict on-going cutbacks with school nursing positions.


References

Dessler, G. (2015). Human resource management(14th ed.). Upper Saddle River, NJ: Pearson.
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Miller, S. (2016). Employers seek better approaches to pay for performance. Society for Human
Resource Management. Retrieved from https://www.shrm.org/resourcesandtools/hr-topics/compensation/pages/better-pay-for-performance.aspx

Orange County Department of Education. (2017). Salary schedules. Retrieved from
http://www.ocde.us/Administrative/Pages/Reports-and-Publications.aspx

Wang, L. Y., Vernon-Smiley, M., Gapinski, M. A., Desisto, M., Maughan, E., & Sheetz, A.
(2014). Cost-benefit study of school nursing services. JAMA Pediatrics, 168(7),
642-648. doi:10.1001/jamapediatrics.2013.5441