Student Healthcare Access - A Right and Not A Privilege
It is the position of the National Association of School Nurses (NASN) that all students should have access to health care. Quality healthcare services are critical for health promotion and prevention, health maintenance, disease prevention and management, and health equity among individuals (Office of Disease Prevention and Health Promotion (ODPHP), n.d.a). Absence of health insurance contributes to lack of access to healthcare, which directly impacts student’s ability to learn.
Healthy People 2030 defined access to health services as “the timely use of personal health services to achieve the best possible health outcomes” (ODPHP, n.d.b). Overall health is fundamental to a student's growth and development. Students with unmet health-related needs have difficulty engaging in the educational process (American Academy of Pediatrics, 2016). Lack of insurance coverage, in addition to family violence, homelessness, lack of preventative healthcare, poor nutrition, poverty, and substance abuse, are all barriers that negatively affect students' health and learning (The Annie E. Casey Foundation, 2018). Geographic, informational and economic limitations must be removed to allow for smooth access to healthcare (Children’s Health Fund, 2016). Health literacy and personal understanding of healthcare insurance policies are examples of informational challenges for families. According to the Kaiser Foundation (2018), most uninsured people cite the high cost of health insurance as the primary reason for lack of insurance. Additionally, Kaiser (2018) notes that lack of U.S. residency is also a barrier. Undocumented immigrants qualify for emergency Medicaid only. Permanent immigrants are not eligible, even if they meet program qualifications for Medicaid, until they have been a U.S. resident for 5 years. Refugees and asylees do not have to wait 5 years to qualify for Medicaid or the Children’s Health Insurance Program (CHIP) (Kaiser, 2018). Policies to ensure students maintain insurance coverage without gaps can improve access to health care (Leininger & Levy, 2015).
Healthcare access by all students is an essential factor that can improve the overall health and wellness of society. School nurses remove barriers to healthcare access and provide direct care, care coordination and case management to students in need (Maughan, Duff & Wright, 2016). It is the position of NASN that all students have equitable access to healthcare.
American Academy of Pediatrics. (2016). Role of the school nurse in providing school health services. Retrieved from https://pediatrics.aappublications.org/content/pediatrics/137/6/e20160852.full.pdf
Children’s Health Fund (2016). Unfinished business: More than 20 million children in U.S. still lack sufficient access to essential health care. New York, NY: Author.
Kaiser Family Foundation. (2018). Key facts about the uninsured population. Retrieved from https://www.kff.org/uninsured/fact-sheet/key-facts-about-the-uninsured-population/
Leininger, L., & Levy, H. (2015). Child health and access to medical care. The Future of Children, 25(1), 65-90.
Maughan, E. D., Duff, C., & Wright, J. (2016). Using the framework for 21st-century school nursing practice in daily practice. NASN School Nurse, 31(5), 278–281. https://doi.org/10.1177/1942602X16661558
Office of Disease Prevention and Health Promotion. (n.d.a). Healthy People 2030 Framework. Healthy People 2030. U.S. Department of Health and Human Services. https://health.gov/healthypeople/about/healthy-people-2030-framework
Office of Disease Prevention and Health Promotion. (n.d.b). Access to Health Services. Healthy People 2030. U.S. Department of Health and Human Services. https://health.gov/healthypeople/objectives-and-data/social-determinants-health/literature-summaries/access-health-services
The Annie E. Casey Foundation (2018). 2018 Kids Count data book: State trends in child well-being. Baltimore, MD: Author.
Acknowledgement of Authors:
Julia Lechtenberg, MSN, BSN, RN, NCSN
Doreen Crowe, MEd, BSN, RN
Linda Compton, MS, BSN, RN
Lori Haapala, BSN, RN, NCSN
Karen Elliott, ADN, RN
Sharon Bailey, MSN, BSN, RN
Adopted: September 2019
Revised: August 2021
This position brief replaces the position statement titled Patient Protection and Affordable Care Act: The Role of the School Nurse.
Suggested citation: National Association of School Nurses. (2021). Student access to healthcare - A right and not a privilege (Position brief). Silver Spring, MD: Author.
“To optimize student health, safety and learning, it is the position of the National Association of School Nurses that a professional registered school nurse is present in every school all day, every day.”
All position briefs from the National Association of School Nurses will automatically expire 18 months after publication unless renewed and recommended for position statement or other NASN document development.