The Impact of Worksite Clinics on Teacher Healthcare Utilization and Cost, Self-Reported Health Status, and Student Academic Achievement Growth in a Public School District

Published in: Journal of Occupational and Environmental Medicine [Epub May 2018]. doi: 10.1097/JOM.0000000000001373

Posted on on July 03, 2018

by John Engberg, Jon Harris-Shapiro, David Hines, Patti McCarver, Harry H. Liu

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Research Question

  1. How would access to school-based health care clinics affect health care utilization and cost, teacher health, absenteeism, and job performance in a public school district?


To examine the impact of worksite clinics on health care utilization and cost, self-reported health status, and student achievement growth in a public school district.


We used insurance claims, health risk assessment, and student achievement growth data for active teachers during 2007-2015. A difference-in-differences approach was applied to measure the impact of worksite clinics.


Compared to using a community-based clinic as the usual source of primary care, using a worksite clinic was associated with significantly lower inpatient admissions (53 vs. 31 per 1,000 teacher years), annual health care cost ($5,043 vs. $4,298 in 2016 US dollars, a difference of $62 per teacher per month), and annual absent work hours (63 vs. 61). No significant differences were detected in self-reported health status or student achievement growth.


Worksite clinics reduce teacher health care cost and absenteeism.

Key Findings

  • Teacher use of school-based primary care was significantly associated with reductions in health care utilization, cost, and absenteeism.
  • School-based clinic use was not associated with improvements in teacher self-reported health status or job performance as measured by student academic achievement growth.
  • Having clinics at the same location or near schools may help facilitate relationship building between employees and providers.
  • The finding of lowered primary care visits was unexpected, and may signal a difference in quality in comparison to care available at community-based clinics.
  • Additional research is warranted regarding improvements in health status.

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