Health Care Needs and America's College Students: Public Health Dilemma or Opportunity? Though Regarded as a Desirable Population by Health Insurers, Your Students May Be Underinsured, and Institutional Clinics Are Lagging. Here's How Some Universities Are Tackling the Problem

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With health care insurance inflation in the double digits for the third year across all sectors of the American population, colleges and universities across the United States continue to think about how to best provide insurance for their students.

It doesn't make matters any simpler that the uninsured population in this country remains at a stable and unacceptably high level to many. Some are clamoring that unpaid medical bills are one of the main reasons why students leave their college education incomplete.

And though scholastic hard-waiver and mandatory health insurance programs are becoming more and more of the norm, they may not be enough for some, especially as small communities surrounding college towns are sometimes left to cope with the burden of providing care to students. Meanwhile, a few institutions lucky enough to operate medical schools or own hospitals may have discovered a successful formula for providing these benefits in the era of managed care's decline.

Membership Has Its Privileges

While insurance companies have usually been thought of as favoring younger, healthier populations with lower insurance premiums, that principle may be of little consolation to those college students who happen to be underinsured or who Lack health insurance altogether.

"According to the U.S. Census 2002 report, young adults ages 18 to 24 were less likely than any other age groups to have health insurance," says Sharon Fisher, communications coordinator for the American College Health Association (ACHA), a national organization made up primarily of individual members in college health services departments. Only 70.4 percent of young adults in that age range were insured in 2002, Fisher says.

The problem is indeed serious, agrees Ralph Manchester, director of University health services at the University of Rochester in New York. According to Manchester, some 25 percent of America's 18 million college students are some combination of underinsured or uninsured.

As part of an attempt to mitigate the problem, the ACHA has participated in Cover the Uninsured Week for the last several years, according to Manchester, who is a former president of the organization.

A big part of the problem is the double-digit health care inflation that has been affecting the entire country consistently for the past several years. Alan I. Glass, director of student health and counseling at Washington University in St. Louis, explained how the phenomenon was affecting his institution. "We've been seeing 24 percent inflation, which has made it a challenge negotiating premiums with the insurance company," Glass says, noting that premiums were increasing by 30 percent for next year.

To deal with the public health aspects of the issue, Washington has joined a growing number of institutions in formulating a "hard-waiver" policy. "Nationally, 17 percent of college students are uninsured, accounting for about 10 percent of the country's uninsured population," Glass says. "With the hard-waiver policy, the students have to prove that they have adequate coverage in order to enroll.

"The difficulty is that from an administrative perspective, it can be incredibly costly and difficult to manage. You have to have somebody keep records of the documentation, and things can happen at mid-year. For instance, at the beginning of the year they may be covered by their parents, but then their parents may lose coverage," Glass says.

Cornell University has a hard-waiver plan, but the school did a study in 1999 and found that 8 percent of their enrolled students did not have coverage at mid-year. And 35 percent had coverage which was less than adequate, Glass says.

Providing coverage for their students might be more than simply being a good citizen for American colleges and universities; it might add to re-enrollment and graduation rates.

Consider a 2000 study by the California Board of Regents which found that the No. …