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End Note

Ailing College Health Programs

Cures for college-sponsored program woes
University Business, Jul 2008

AMERICA'S COLLEGE HEALTH systems are gravely ill. Unless faculty and campus administrators address these coverage issues, students could be one disease or accident away from losing the education for which they are paying.

Insurers make big profits from college students, but some families are left with huge bills. College-offered health insurance programs often offer little for the money. Benefits ceilings are low-usually $30,000 or less-even though for the same money, better programs are available outside school.

Further, "interior caps" put an even lower ceiling on specific categories, such as surgeon's fees, hospital room and board, and even daily allowed expenditures. Prescription drug coverage is similarly low, and a huge number of exclusions are put into place by college-sponsored plans.

Colleges are not getting good deals on health insurance for their students.

These plans' limited coverage makes them tremendously profitable for insurers. In general, the "loss ratio," or amount spent by an insurer on services, should be about 80 percent of premiums, leaving 20 percent for administration and profit. Yet insurers in plans offered by colleges have much lower loss ratios-some as low as 50 percent-yielding double to triple the standard market amounts. These profits also show that colleges are not getting good deals for their students.

Things aren't much better for students with insurance through their parents. Surveys show that three out of four students are covered by their family's health plans. While traditional health insurance normally provides access to vital medical services, this access is denied in college health center programs.

Further, these college programs usually carry high out-of-pocket costs for key services such as laboratory and imaging studies-if they are covered at all.

Some universities justify this situation by saying that the spate of services with limited or no coverage can be reimbursed by the student's or family's health insurance. However, as many of us know, the Byzantine process of forms, receipts, claims, and follow-up make this effort at reimbursement an extremely daunting exercise at best.

College health programs represent financial aid for health insurers paid for by college students and their families. Insurers gain large profits off the deductibles and caps in these plans. They also avoid payment for services provided by denying out-of-network reimbursements.

So students who get sick may engage in high-risk behavior to reduce costs, such as buying drugs online and avoiding physician oversight and management of their illness. They'll avoid necessary care, allowing their disease or injury to get worse (and all that more expensive to treat later). If they must enter the individual health insurance market after college, they'll either not get it because they have an expensive pre-existing condition, or it will be so expensive they will be priced out of the market or spend an inordinate fraction of their income on it.

Colleges and universities have a social obligation to ensure that their actions inure to the public good. Faculty and administrators are obligated to access and maximize all available resources for the benefit of the present and future generations of students and families that put their trust in us. In this role, we need to terminate financial aid to health insurers. Two critical strategies can address the situation:

Shop better and then aggressively negotiate for insurance. Ensure that the insurers are using premiums to provide appropriate benefits. Monitor loss ratios, and avoid Draconian exclusions or caps that are not in the best interest of the student. Colleges have the power of numbers and can negotiate reasonable health insurance programs and prices.

Allow students to use their family health insurance for college health services. This is beneficial for both students and the school. Students could then rely on their coverage and not pay inflated prices for care.

For institutions, surpluses for billing insurers for the services may accrue. Using these surpluses, colleges can provide uninsured students with health insurance scholarships or grants, expand services, and update technology in college health centers.

Colleges and universities further their educational mission and social impact only through a healthy student body. Reaching this goal requires attention to curing our ailing college health programs. Thankfully, the treatments are available. We need only administer them properly.

<em>Bryan A. Liang is a faculty member and executive director of the Institute of Health Law Studies at California Western School of Law in San Diego.</em>