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

Engberg, John B. PhD; Harris-Shapiro, Jon BS; Hines, David BA; McCarver, Patti DNP, FNP-BC; Liu, Harry H. PhD

Journal of Occupational and Environmental Medicine: August 2018 - Volume 60 - Issue 8 - p e397–e405
doi: 10.1097/JOM.0000000000001373

Objective: The aim of this study was 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.

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

Results: Compared with 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 1000 teacher years), annual health care cost ($5043 vs $4298 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.

Conclusion: Worksite clinics reduce teacher health care cost and absenteeism.

RAND Corporation (Dr Engberg), Pittsburgh, Pennsylvania; RAND Corporation, Boston, Massachusetts (Dr Liu); Continuance Health Solutions Inc. (Mr Harris-Shapiro); Metro Nashville Public Schools (Mr Hines); Vanderbilt University Medical Center (Dr McCarver).

Address correspondence to: Harry H. Liu, PhD, Policy Researcher, RAND Corporation, 20 Park Plaza, Suite 920, Boston, MA 02116 (

Funding for this study was provided by Robert Wood Johnson Foundation, Grant ID: 73462.

The authors have no conflicts of interest.

Supplemental digital contents are available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal's Web site (

Copyright © 2018 by the American College of Occupational and Environmental Medicine