Planning and sustaining a school-based health center: cost and revenue findings from Oregon.

Objective: Research concerning school-based health center (SBHC) costs and revenues is limited. This article discusses Oregon's SBHC State Program Office methodology and findings regarding costs and revenues for planning and operating Oregon SBHCs.

Methods: A variety of data sources and case studies conducted in five Oregon SBHC systems were used to calculate startup and annual operations costs. All Oregon SBHCs completed a survey providing 2005-2006 revenue data. Revenue data were further linked to 2005-2006 client utilization data, such as the number and age of unduplicated clients, public and private insurance status, and medical sponsor type.

Results: Startup costs for Oregon SBHCs depended largely on the status of available space. Median, minimum, and maximum annual operations costs were calculated for core, intermediate, and expanded models of service delivery, and depended mostly on provider hours and types. Centers with federally qualified health center medical sponsors rely heavily on revenue from billing public insurance programs. Billing revenue depends on the percent of uninsured visits. School socioeconomic indicators such as the percent of students eligible for free and reduced lunch may be good indicators for the percent of student clients with public insurance.

Conclusions: The methodology employed may encourage other state SBHC agencies or organizations to adopt research designs to collect and analyze cost and revenue data. On a practical level, the findings provide state and local policy makers and communities planning SBHCs with preliminary estimates for the costs of startup and annual operations, and some understanding of income sources and billing revenue projections.