Association for Public Policy Analysis & Management

This paper focuses on a case study of an application of GIS software in analyzing the availability of school-based health centers (healthcare clinics located directly on a school campus, often called SBHCs) in California. GIS have been used extensively in many of the physical and life sciences and is also useful in the social sciences (Fang, 2006; Steinberg & Steinberg, 2005), including education. As SBHCs are not centrally organized nor are they a government initiative, their grassroots nature means it is difficult to ascertain where they all are located and how they fit into the existing healthcare infrastructure. This study looks at a specific subset of SBHCs, those with a dental provider (referred to as SBHC-DPs) and uses GIS to answer the questions:

1. What is the geographic distribution of SBHCs with a dental provider (SBHC-DP) in California?
2. What is the relationship between the location of an SBHC-DP and the location of dentists that accept public health insurance (specify two programs) in California? Are these two categories of providers serving the same communities?
3. What are the descriptive characteristics of communities with SBHC-DPs and how do they compare to communities without SBHC-DPs?

We used several data sources. First, directory information for all the SBHCs in California was obtained from the advocacy group, the School-Based Health Alliance. We obtained a dataset of Medi-Cal’s pediatric dental providers from the California Department of Health Care Services. US ZIP code tabulation areas and their median incomes was obtained from the US Census Bureau. Lastly, the shapefiles, specific file types that provide spatial data to the GIS, came from several government agencies.

By using GIS analysis, we were able to determine an overview of the locations of California’s SBHC-DPs. These clinics mostly cluster in subsets of urban areas. When compared with Medi-Cal pediatric dental providers, the service areas greatly overlap. On average, another Medi-Cal provider is only 0.53 miles (865 meters) away, and only two of the 80 SBHC-DPs in the state are in an area where there is not a Medi-Cal provider within a 5 mile (8km) radius. After communities were identified using the GIS results, we were able to look at their income distributions. On average, ZIP codes with an SBHC-DP have a significantly lower median household income than the overall state average. However, there was a specific subset of SBHC-DP communities in the state where the median household income was nearly double the state’s average.

As schools and communities in California contemplate how to use their resources to provide services to students and families, this kind of information is useful in determining what type of services may be most needed by the local community. Furthermore, geographic-based information can help guide higher level policies to encourage the spread of needed healthcare services to areas that are lacking: the “dental deserts” in this case. As this project progresses, we continue to look for patterns in how SBHCs are occurring and how this information can identify ideal locations for future expansion.