Mission Creep at the Infirmary

Next month, the UNC Board of Governors Committee on Budget and Finance will vote on UNC-Chapel Hill’s health services fee. The committee has already approved health fees for the other campuses but stopped short at Carolina’s  $436-per-year fee after learning that UNC-Chapel Hill is spending some of it on dubious projects.

At Carolina, the fee has paid for staffers for Interactive Theatre Carolina, which, according to a UNC website, “uses scripted and improvisational performances to promote discussions about health, wellness and social justice.” The fee also covers the salary of a “strategic planner for diversity initiatives,” and it helped sponsor  “Orgasm? Yes, Please!” a campus event that provides a “fun, educational look at sexual health, relationships, and pleasure!”

The health services fee, which brings in more than $12 million in revenues to UNC-Chapel Hill, is intended to finance health and medical services for students, including the operation of student health centers. But with the advent of mandatory health care—the university system requires all students to have insurance—student health centers are showing signs of costly mission creep.

The price to students for these services is not insignificant. Across the UNC system, the health service fee ranges from $141 at Fayetteville State University to $820 at UNC School of the Arts (where performance injuries are common). UNC-Chapel Hill’s fee is the second-highest in the system.

By using the health center, students save $20 per visit because they aren’t charged the co-pay required elsewhere under the mandatory insurance plan. However, they have to pay $287.46 per year (on average) for the privilege (see table).

In addition to the health fee, all degree-seeking students who are enrolled for least six credit hours are required to purchase health insurance. Since 2010, UNC has had a “hard waiver” policy: students must purchase the UNC plan unless they can submit proof that they already have insurance. Sold by Blue Cross Blue Shield of North Carolina, the plan costs $1,376 per year, down from $1,418 in 2012-13.

The Student Blue plan covers everything from check-ups to obstetrics to substance abuse counseling and has been changing to comply with the dictates of the Affordable Care Act. In ACA terms, it’s “Gold” coverage for a “Bronze” price. This is because the pool of people who are covered are, for the most part, young and healthy. While the $1,376 figure is considerably more than the $549 to $679 range quoted by insurers when a system-wide plan was first under consideration in 2009, it is competitive with current prices. The university’s large number of students gives it considerable negotiating power.

So, with all students on “Gold” health care plans, why do they need to pay health fees?

Before the ACA was passed, health centers worked in a complementary way with health insurance. Centers were available, usually at no charge, for walk-in visits, check-ups, and women’s health issues. Insurance was required for more expensive health problems, and students could (and did) go to other offices for those.

Today, however, the different kinds of services are not so clear-cut. Indeed, some services—like primary care and women’s health visits at some schools—appear to be paid for twice. For example, UNC-Chapel Hill’s Campus Health Services website reports that students’ annual fees support “unlimited provider visits in the Primary Care Clinics,” while a list of Student Blue benefits includes “100% coverage for Preventive care at Student Health Center and in-network providers.”

UNC-Chapel Hill’s is clearly a “Cadillac“ health center—not surprising considering that it is receiving both hefty fees and insurance payments. The service employs seven primary care doctors, four psychiatrists, eight psychologists, six social workers, 11 athletic trainers, and dozens of additional doctors, nurses, and staff. Students have access to walk-in therapy sessions, after-hours urgent care, and the full range of women’s health services. It even offers nutrition counseling, tailored nutrition plans from registered dietitians, and access to “sexperts” who provide sex health counseling.

But such luxury is not available at every campus. Across the system, care varies considerably. Many UNC campus health centers employ mostly doctors but others employ only physician’s assistants. Elizabeth City State’s Student Health Services, for example, has a staff of five. Physicians are only available 28 hours per week.

At a time when tuition and fees have been increasing almost continually, it’s important for students to get the most bang for their healthcare buck. At UNC-Chapel Hill, and maybe several other schools in the system, students are paying for more health care than they need, and the university is clearly using the fee for boutique services and non-health related spending. At others, however, this may not be the case. The Board should do a thorough analysis of all health center receipts and spending before next year’s fees are considered.