The Philadelphia School District is considering outsourcing its health services, officials said Wednesday - a move that might mean privatizing jobs held by unionized school nurses.

Superintendent William R. Hite Jr. said the district, rocked by years of brutal budgets, has to find a way to expand medical services and was exploring bringing in private providers to do so.

"With the significant cuts that we've made, it's impacted our ability to deliver health services to all children that need those services," Hite said.

Jerry Jordan, president of the Philadelphia Federation of Teachers, which represents nurses, called any effort to privatize nurses "a shortsighted, Band-Aid solution."

"With over 26 percent of our city's families living in poverty, the school nurse is the only medical professional many children see for health care," he said. "The district should not attempt to save revenue on the backs of poor students."

In negotiations, the district wanted to remove language from the contract that required school nurses, Jordan said. The PFT refused.

In 2011, the district employed 283 nurses; now, it has 183. Most schools are unable to afford the services of a full-time certified health-care worker, although many city children require care for medical conditions, especially asthma.

The school system on Wednesday issued a request for proposals asking for companies to suggest "bold and innovative" ideas for reinventing school-based health care. The document said a vendor could, for instance, propose full-blown centers with primary care, mental and dental services; handle staffing services only; manage billing services to maximize reimbursements; or a combination of those things.

Hite and Karyn Lynch, the district's executive for student support, told reporters Tuesday that they did not know what health services will look like in the fall, but that new approaches could be phased in or piloted at a small number of schools. Proposals are due June 10.

"We're not predicting what the model is going to look like as much as we are seeking to see what might be available and what might benefit the students that we serve," said Lynch.

Any new initiative must not cost the district more than it's currently paying - $23.7 million annually on health-care services. That sum represents the cost of salary and benefits of school nurses, Lynch said - about $130,000 per nurse per year.

Possible operators could make money by billing insurance companies, private and government, for health services, Lynch said. They might also have grants or endowments to do public health work.

"It would be ideal if some of the hospitals in the area that are providing services to children responded to our proposal," she said. "It would be ideal if PFT responded to our proposal and provided a way that we might be able to better afford health services and augment our services."

Operators of existing school health firms say they can make money through government insurance billings for services rendered inside school buildings.

Hite said he valued school nurses, who "have been doing extraordinary work. This is an attempt to also provide them with hopefully what could be a resource or more resources that will provide for more children having access to quality care."

Asked whether the plan could lead to the phasing out of traditional school nurses, Lynch said that officials "could not predict that," but the proposal request clearly lays it out as a possibility.

The request for health-care proposals comes on the heels of the district moving to outsource substitute-teaching services. In April, district officials announced they would privatize 1,324 now-unionized substitute jobs to cut costs and fill more positions.

Some schools and districts have outsourced some or all school health services. At a School Reform Commission meeting in January, current staff described how a lack of nurses hurts schools, staff and students. On days when schools have no nurses, principals and other nonmedical staff are responsible for dispensing medications and assessing students' health concerns.

Principals said they fear making medical mistakes, and nurses said they feel as if they can never serve all students adequately when they must dash from one school to another.

At the SRC meeting, district officials brought in two local health nonprofits to discuss their models.

Education Plus runs school-based health centers, including ones at Philadelphia charters, providing school nursing, acute care and well visits, as well as mental-health screenings and reproductive health services.

The Oral Health Impact Project provides dental services to students inside some district schools at no cost to the district, and an official said at the January meeting that "this model could be duplicated for all health-care needs throughout the district."

Donna Cooper, executive director of Public Citizens for Children and Youth, has been briefed on the privatization proposal and said it appeared to be a good one, provided vendors would guarantee reliable, high-quality care.

Expanding health services inside city schools is a must, Cooper said Wednesday.

"We want to make sure that all of our children are in the hands of quality health-care providers," she said. "If that can be assured in a different model, great."

Beth Mattey, a school nurse in Delaware and president-elect of the National Association of School Nurses, said that while outsourcing health services is by no means a trend, other districts have gone the same route in times of financial distress.

Some models have been successful, with schools working together with organizations to provide strong health services. Still, she said, there are potential concerns.

"If they're doing this to save money, are they going to be paying nurses less money?" Mattey asked. "School nursing is a specialty practice. We don't want more silos. We want the education community and the health-care community to work together."