Health services at large public institutions: funding, utilization, and staffing.

When a mandatory health fee policy for students on campuses of the State University of New York (SUNY) was instituted in fall 1991, the projection was that the policy, which was at the option of individual institutions, would result in significant changes for SUNY health service operations. The changes would affect funding sources, staffing requirements, utilization rates, and services offered. In the past, the SUNY system had been inconsistent in health fee policies. This study was conducted to assist in implementing the mandatory health service fees. The authors surveyed 53 public higher education institutions viewed as comparable to the University at Buffalo in terms of location in an equivalent state, enrollment of 10,000 or more students, similar academic disciplines, average SAT scores, faculty salaries, and graduate enrollment. Two institutions that no longer met the original criteria were not included. The final tabulation was based on data from 42 institutions, for a return rate of 82%. Survey results showed that public higher education institutions are significantly altering traditional practices associated with student healthcare. Health services are providing more specialty services, increasing the focus on wellness and health education, seeking accreditation, and increasing student representation in decision making. In addition, funding sources have shifted dramatically, with a larger percentage of the student health budget derived directly from fees assessed to students and a much smaller percentage derived from institutional or state appropriations.