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Philadelphia May Create H.M.O. for Students

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Citing research that has shown a link between poor health and low student achievement, the president of the Philadelphia school board has proposed establishing a health-maintenance organization, or hmo, for all the city's schoolchildren, many of whom lack access to proper health care.

The president, Herman Mattleman, made the proposal Sept. 14 at a regular meeting of the school board.

In a prepared statement, he announced that the board would "explore the feasibility" of establishing a student hmo as part of a broad effort "to facilitate improved access to health care for all children enrolled in its schools."

Last week, Mr. Mattleman said in an interview that he had discussed the hmo idea with a number of local health-care experts and the entire school board before advancing the proposal.

"While I don't have it nailed down in terms of dollars and cents," hesaid, "I do have a general sense that this idea is doable."

An hmo is a prepaid medical service in which members normally pay a monthly or yearly fee for all health care, including hospitalization. With patients' costs fixed in advance, such services normally stress preventive medicine in an effort to avoid costly treatment.

Termed 'Exciting Idea'

Julia G. Lear, co-director of the Robert Wood Johnson Foundation's school-based programs for adolescent health care, said last week that she knew of no other district that had proposed such a service.

"I've never heard of anything like this," said Ms. Lear, whose program funds health projects in schools across the country.

"It's an exciting idea," she said. "There is no reason why a school system couldn't be the instigator to make something like this happen."

Mr. Mattleman said the district is in the process of establishing a committee that will explore the idea further and develop other strategies for improving the health of the district's children. Committee members, he said, will include parents, educators, health-care providers, and representatives of local medical schools, advocacy groups, and government agencies.

"We have within this city the resources, the technology, and the talent to guarantee that all of our citizens, but especially the children, have the best health care in the nation," Mr. Mattleman said at last month's board meeting. "It is not acceptable that so many of our children are so unhealthy."

11 Percent in 'Poor' Health

Nearly 11 percent of Philadelphia's children under the age of 17 are in "fair or poor" health, more than double the national percentage for the same age group, according to Lynne Kotranski, director of research and evaluation for the Philadelphia Health Management Corp.

Children from low-income families, she said, are three times more likely to be in poor or fair health than other children.

"What we want to do is raise the consciousness of the community to this problem, and not let them smugly assume that kids, just because they are kids, are well," Mr. Mattleman said last week. "We have to make sure kids come to school well, and if they aren't, then we have to figure out ways to make sure that their health needs are responded to."

The hmo proposal and the establishment of the committee are part of a multi-faceted school-board strategy to improve the overall health of the city's children, Mr. Mattleman said.

He said the board would also ask the district's administration to take steps to integrate health education into other areas of the curriculum, such as reading, science, and social studies; to expand programs that teach students how to use existing health-care systems; and to develop new ideas for helping parents seek out and use existing health care facilities for themselves and their children.

In addition, he said, the board will co-sponsor with other local organizations and public agencies a series of conferences on school-related health issues.

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