College Student Health Care Costs, Insurance Coverage, and Measures to Protect Confidentiality for Sexually Transmitted Disease Services

Background: College students often engage in high risk behaviors increasing their risk for STD.  Studies analyzing student access to STD services and policies to protect confidentiality are limited.  Using data from the College Health Services Survey (2014-2015), we analyzed insurance coverage, health fees, and measures to protect confidentiality.

Methods: Weights were applied to increase generalizability. Chi-squares were used to analyze health insurance and services by college type and minority serving institution (MSI) status and to determine if referral facility type was influenced by student health fees and/or mandatory insurance coverage.  Confidentiality-related policies were categorized based on identified themes from open-ended responses and assessed by college type and US Census region. 

Results: We restricted the sample to 384 (79.7%) institutions that had a health center and/or a sponsored insurance plan. For full-time students, 53.4% of 4-year institutions and 15.3% of 2-year institutions required insurance (p<0.01). More 4-year institutions (61.0%) sponsored insurance plans than 2-year (35.1%, p<0.01).  Only 10.5% of 4-year and 8.7% of 2-year institutions offered all STD testing and/or visits for free; 39.7% reported that students sought STD services elsewhere given high costs. Most 4-year (42.4%) and 2-year (36.3%) institutions billed all tests to the patient or patient’s insurance.  Of institutions that referred students for STDs to family planning clinics (60.7%, p<0.05) or private doctors’ offices (70.1%, p <0.01), most had a health fee for undergraduate students. 50.5% had processes for protecting confidentiality. More non-MSIs (20.9%) reported self-pay as an option to protect confidentiality than MSIs (3.0%, p<0.01). Colleges in the Northeast (17.1%) were most likely to refer students to another provider to protect confidentiality (p<0.01).

Conclusions: Colleges often have health fees and mandatory insurance which may increase student access to STD services.  However, efforts to protect confidentiality of STD services often place additional burden (cost and referrals) on students.