How colleges fit into the U.S. healthcare paradox

The United States spends more on healthcare than any other wealthy nation (by a lot), yet our population’s health outcomes lag behind those of peer countries.¹ This paradox matters for colleges because campuses sit at a unique crossroads: they both experience the downstream effects of a costly, fragmented health system and have the structures to intervene early, equitably, and at scale. If higher education leaders and campus health teams treat the college years as a strategic point of prevention and access, they can minimize downstream costs and improve outcomes for students now and across their lifetimes. 

In 2023, U.S. health spending per person exceeded $13,000 — roughly double the average of comparable high-income countries — while life expectancy and other population health metrics remain worse than peers.² These figures signal inefficiencies (higher prices, administrative overhead, fragmented care) and inequities (unequal access, worse outcomes for disadvantaged groups) that show up in delayed care, high medical debt, and avoidable morbidity. 

Two of the most striking examples are life expectancy and infant outcomes. Even after a small rebound from pandemic declines, U.S. life expectancy in 2023 remained several years below comparable countries, reflecting a mix of causes, like chronic disease, injury, maternal and infant health disparities, and social determinants.² While infant mortality has improved over time, the U.S. rate has not improved at the same pace as other high-income nations, and is especially problematic in Black communities.³  

How do colleges fit in? 

Where do colleges fit into this national picture? Colleges and universities interact with health at three strategic levels: access, prevention/early intervention, and data-driven population health. Campus health and counseling centers are front-line access points for primary care, behavioral health, sexual and reproductive services, immunizations, and health promotion — services that, if well-designed and equitably available, prevent more costly care later. A strong campus health and well-being infrastructure and data tools like the ACHA National College Health Assessment (ACHA) and Healthy Minds Study (HMS) give institutions the ability to identify needs and measure outcomes across student subgroups.^4,5 

Since colleges serve a relatively discrete and age-defined population at a formative life stage, systemic investments have outsized returns in both human and fiscal terms. Preventing or successfully managing chronic conditions in young adults reduces years of morbidity, lowers lifetime spending, and supports academic success — a core mission for higher education. 

What can we do? 

Practically, colleges can help address the cost–outcome gap by concentrating on four high-impact areas: 

1. Expand affordable primary and behavioral health on campus. Reliable access to primary care and mental health services reduces emergency visits and unmanaged chronic conditions.^6,7 For students without family physicians or with insurance gaps, campus health services are often the only accessible option. Investing in extended hours, telehealth, and flexible fee schedules keeps care timely and less costly overall. 

2. Use campus data for targeted prevention. Population-level health and well-being surveys and campus EHRs let colleges spot rising trends (anxiety, sleep disturbance, binge drinking, and unmet contraceptive needs), and target policies and programs to at-risk groups. Data-driven prevention is cheaper and more effective than late-stage treatment.  

3. Address social determinants in partnership. Food insecurity, unstable housing, transportation barriers, and financial strain are common on many campuses and directly affect health.⁸ Integrating health services with student affairs, financial aid, housing, and food programs creates holistic solutions that reduce future medical costs and improve retention. 

4. Strengthen transitions and referrals to the broader health system. Students frequently leave campus care during breaks, after graduation, or when specialized care is needed. Strong referral networks, clear cost-transparency counseling, and partnership agreements with local providers can reduce gaps that lead to delayed care and higher downstream costs. 

Designing equitable, cost-efficient, and outcome-driven practices can be done by mapping current service capacity against data-derived needs, piloting expanded low-barrier access points (i.e., telehealth, expanded hours), creating cross-sector referral agreements that reduce fragmentation, and evaluating outcomes with rigor. When campuses measure and share outcomes like reduced ED visits, improved mental health, and higher retention, they make the case for sustained investment in health and well-being. 

The U.S. health-spending paradox won’t be solved by any single sector, but colleges can be a lever. By providing accessible care, targeting early prevention, addressing social drivers, and using robust campus data, higher education institutions can both improve student health and bend the long-term cost curve. For campus leaders, providers, and payers, that’s a mission-aligned and cost-savvy opportunity worth seizing. 

Stay updated on student health trends by subscribing to the Campus Health 360 Newsletter for monthly updates. 

References 

1. How Does the U.S. Healthcare System Compare to Other Countries? (7 Oct 2025). Peter G. Peterson Foundation. Accessed on December 19, 2025. https://www.pgpf.org/article/how-does-the-us-healthcare-system-compare-to-other-countries/ 

2. Wager, E., McGough, M., Rakshit, S., Cox, C. (9 Apr 2025). How does health spending in the U.S. compare to other countries? Peterson-KFF Health System Tracker. Accessed on December 19, 2025. https://www.healthsystemtracker.org/chart-collection/health-spending-u-s-compare-countries  

3. Executive Brief, 2023 Annual Report. (2023). America’s Health Ranking, United Health Foundation. Accessed on December 19, 2025. https://assets.americashealthrankings.org/ahr_2023annual_executivebrief_final-web.pdf  

4. National College Health Assessment. (n.d.). American College Health Association. https://www.acha.org/ncha/  

5. The Healthy Minds Study. (n.d.). Healthy Minds Network. https://healthymindsnetwork.org/hms/  

6. Healthy People 2030. (n.d.). Department of Health and Human Services, Office of Disease Prevent and Health Promotion. Accessed on December 19, 2025. https://odphp.health.gov/healthypeople/priority-areas/social-determinants-health/literature-summaries/access-primary-care  

7. Reducing Unnecessary Emergency Department Visits. (n.d.). Center for Medicare and Medicaid Services. Accessed on December 19, 2025. https://www.cms.gov/priorities/innovation/files/x/tcpi-changepkgmod-edvisits.pdf 

8. Mowreader, A. (29 Apr 2025). Survey: Financial Struggles Impede Students’ Academic Progress. Inside Higher Ed. Accessed on December 19, 2025. https://www.insidehighered.com/news/student-success/college-experience/2025/04/29/college-students-lack-housing-food-reliable  

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