The Role of School-Based Health Centers in Mitigating Insurance-Based Disparities in Rural Preventive Care Utilization

OBJECTIVE: This study examines whether school-based health center (SBHC) access mitigates insurance-based disparities in preventive care utilization, including well-child visits and influenza (flu) vaccination, among students with healthcare visits in a rural region of New York State. METHODS: Using 2024 electronic health records from a regional healthcare network, we analyzed 15,267 students aged 5-18. Students were categorized by SBHC access and insurance type (Medicaid vs. commercial). Logistic regressions estimated preventive care utilization by SBHC access and insurance type, with marginal effects examining their interaction. Among students with SBHC access, visits were stratified by care site to examine the odds of SBHC and non-SBHC visits by insurance type. Models were adjusted for age, sex, community socioeconomic status, and district random effects. RESULTS: Overall, 53% of students had SBHC access, and 56% were Medicaid insured. Students with SBHC access and commercial insurance had the highest preventive care utilization, while Medicaid-insured students without SBHC access had the lowest. Insurance-based disparities were observed in well-child visits, and were not fully mitigated by SBHC access. However, Medicaid-insured students with SBHC access had higher utilization of well-child visits and flu vaccination than those without access, and had similar odds of well-child visits as commercially-insured students without SBHC access. Among students with SBHC access, well-child visits delivered in SBHCs showed no insurance-based disparities. CONCLUSIONS: Among students using primary care, insurance-based disparities were found in well-child visits. Although SBHCs did not fully eliminate insurance-based disparities, they improved preventive care utilization among Medicaid-insured students in rural areas.