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Amount of Student Health Care Visits Mixed at State Universities

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IOWA CITY, Iowa - The number of University of Iowa students visiting Student Health has declined annually for the past three years, a trend officials say is due in part to staff vacancies at the center but also to students instead seeking treatment at a UI QuickCare clinic near campus.

The UI Student Health usage numbers are opposite from Iowa State University and the University of Northern Iowa, where student health clinics have seen patient numbers grow in recent years.

UI Student Health had a number of physician and physician assistant vacancies for a time, positions that were held open while the clinic had an interim director, said James Kellogg, who became the director in January. Those vacant positions have been filled, which Kellogg hopes will result in more patient visits.

It's likely the opening of several QuickCare clinics, operated by UI Hospitals and Clinics, also has impacted Student Health usage, Kellogg said. Some students may opt to visit QuickCare if they're sick on the weekend, for example, rather than waiting until Student Health is open on Monday, he said.

But officials see Student Health and QuickCare as a "complementary partnership," Kellogg said, rather than competing.

"They're providing services to students, which is good," he said.

One big difference is that many of the services provided at Student Health are covered by the mandatory health fee students pay each semester as part of their bill. QuickCare services are not covered by that fee.

When the first QuickCare clinic opened at Old Capitol Town Center in downtown Iowa City in 2008, it caused confusion for students occasionally, said Harriet Echternacht, a UI Hospitals and Clinics doctor and medical director for the five QuickCare clinics.

Some students would visit QuickCare thinking their costs were already covered by the student health fee. But it's less of a problem now that the Old Capitol location has been open for five years, Echternacht said. Incoming students are told that Student Health is their primary provider and QuickCare services are not covered by the health fee, she said.

"Our services at QuickCare are billed to insurance," she said. "We try to explain the difference to students."

UI senior Stefanie Warshaw, 22, said the fee structure is a consideration for her. She has never used QuickCare but has visited Student Health numerous times. It's on the west side of campus, where she first lived in the dorms, and she figures she's already paying for Student Health via the mandatory fee, which this year is $237.

"I'm a college student and I like to keep my money. I'll definitely go somewhere where it's free as opposed to a charge," the Wheaton, Ill., native said. "If I couldn't get an appointment, maybe at that point I would go to QuickCare."

A lot of students do what's most convenient, said fifth-year senior Alex Novak, who has used QuickCare and Student Health. The choice, he said, often comes down to where students are more frequently on the east side of the campus, where the Old Capitol QuickCare clinic is, or on the west side, where Student Health is located.

"If it's more convenient for me to go to QuickCare in Old Capitol, I just go there," the 22-year-old Aurora, Ill., native said. "I know my insurance will cover it."

QuickCare is there to provide a convenient option for patients with common, acute illnesses, and to help reduce emergency room visits for less-serious conditions, Echternacht said. Since QuickCare is available on weekends and evenings, it's a good partner for Student Health, she said. Another difference is Student Health takes appointments and QuickCare does not.

"We certainly are seeing a lot of students and hopefully keeping a lot of them from going to the emergency room when they don't need to," she said.

QuickCare refers them to Student Health for follow-up care, ongoing health issues or prescriptions, she said. The Old Capitol site is the most-frequented QuickCare clinic by UI students, Echternacht said, with about 50 percent of visits there by students.

QuickCare has seen a gradual increase in its overall numbers as more clinics open, with about 30,000 patient visits in 2011-12, up from about 25,000 the year before. But Echternacht said she believes the student visits have remained mostly steady in recent years, since the Old Capitol clinic was the first to open.

Student visits to the campus health clinics at ISU and UNI are increasing, officials at those universities said.

ISU officials attribute their increase 15 percent more patient visits in the past five years in part to growing enrollment, Student Health Director Michelle Hendricks said. The other influencing factor with student visits is what's happening with communicable illnesses in a particular year, she said. A heavy flu season can mean a spike in numbers, she said.

Shelley Matthews, director of UNI's Student Health Clinic, said she speaks to the parents of all incoming freshman each year, and that has greatly increased awareness of what the clinic offers as part of the $189 annual student health fee.

"We know our audience," she said. "When you're sick, you call your mom. So we're telling the parents and then the parents are telling them."

Utilization of the clinic continues to increase, she said, and mental health services are one area where staff has been added because of demand. UNI also is promoting study abroad, so the clinic tries to educate students about getting travel consultations for health issues, Matthews said. They'd also like to do more with students on health prevention, she said.

"I'm very happy to see our usage increasing," she said. "We are exceeding 50 percent of the student population, which I think is standard in college health."

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