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Asthma is a leading chronic illness among American children. School-based health clinics (SBHCs) reduced expensive ER visits and hospitalizations through better healthcare access and monitoring in select case studies. The purpose of this study was to examine the cost-benefit of SBHC programs in managing childhood asthma nationwide for reduction in medical costs of ER, hospital and outpatient physician care and savings in opportunity social costs of lowing absenteeism and work loss and of future earnings due to premature deaths. Eight public data sources were used to compare costs of delivering primary and preventive care for childhood asthma in the US via SBHC programs, including direct medical and indirect opportunity costs for children and their parents. The costs of nurse staffing for a nationwide SBHC program were estimated at $4.55 billion compared to the estimated medical savings of $1.69 billion, including ER, hospital, and outpatient care. In contrast, estimated total savings for opportunity costs of work loss and premature death were $23.13 billion. Medical savings alone would not offset the expense of implementing a SBHC program for prevention and monitoring childhood asthma. However, even modest estimates of reducing opportunity costs of parents' work loss would be far greater than the expense of this program. Although SBHC programs would not be expected to affect the increasing prevalence of childhood asthma, these programs would be designed to reduce the severity of asthma condition with ongoing monitoring, disease prevention and patient compliance.

The purpose of this paper is to describe and assess one of the first comprehensive residential green-builder programs in the U.S. It compares trends of items used in residential construction during the past five years and reports why participating builders chose to incorporate specific items and their level of commitment to the program. This description provides a baseline of strategies to investigate the effect of this program in developing sustainable communities. The builder study population was derived from a database of registered “green” residences built during 1998-2002 in greater Austin, Texas (2,335 homes and 73 listed builders). Almost half the builders constructed just one “green” home, whereas two builders built almost 75% of the green homes during the 5-year study period. Less than 1% of the homes received a perfect 5-star rating, whereas 87% were rated 1 or 2 stars. The frequency of implementing the 122 green features were compared over time and analyzed for correlation with cost and their associated star-value. Cost was the primary factor determining item use frequency. Participating builders generally concurred that the program was successful and beneficial to homeowners but that the additional work required for participation provided little financial reward for builders. While much can be done with low-cost interventions to reduce the negative environmental impacts of residential construction, builder participation may be enhanced by promotion of some of the higher cost features. In addition, public education about the long-term benefits of green homes is needed to increase homeowner participation, and encourage builders to incorporate more environmentally friendly features in the homes they construct.

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