Correcting Healthcare in Correctional Facilities

How much does it cost to provide health care to inmates? According to a recent study by the Urban Institute, on average, it’s $30 per day for DC taxpayers and hundreds of million dollars annually. Prisons and jails are required to provide health care to inmates at a level comparable to what they would receive if they were not incarcerated. These health services can make up anywhere from nine to thirty percent of corrections costs. In Schaenmen et al’s paper “Opportunities for Cost Savings in Corrections Without Sacrificing Service Quality,” the researchers examine several methods that prisons have tested to contain costs. They frame these suggestions in terms of supply–how to reduce costs or services, or both per treated inmate, and demand–how to reduce inmates’ need for healthcare. The researchers’ recommendations are based on approaches that currently exist in prisons throughout the US and range widely in both scale and scope.

The researchers identify four ways to reduce costs. First, they suggest implementing and expanding telemedicine. This would decrease patient transportation costs and increase access to specialists. Second, they recommend implementing new technologies to decrease the amount of time nurses spend dispensing medication. Automating these repetitive tasks could help decrease medical errors and could ultimately improve the quality of care. Third, by working with other prisons to increase their economies of scale, prisons could improve their bargaining power and negotiate lower cost deals for medications.

The researchers also encourage prisons to continuously seek out less expensive yet equally effective medications to prescribe to patients and increase their prescription of generic drugs. Finally, the researchers recommend cross-training prison employees and hiring lower-paid medical positions, like nurse practitioners or physician assistants, for treating non-critical patients. The researchers find that cross-training often results in improved relationships between correctional officers and inmates and provides more staffing flexibility.

The researchers also suggest five key approaches for reducing inmates’ need for healthcare. First, inmates should be screened upon their intake to identify any pre-existing conditions and treat any current diseases. Better screening can help prevent the spread of infection. Second, patients who are likely to miss their arraignment, due to mental illness or chronic physical health problems, should be sent a reminder note. In Coconino County, Arizona, a reminder system was able to help reduce court no-shows from 25 percent of cases to six percent. Third, many jails have implemented small co-pays for medical visits, which serve as “low-threshold deterrents” for excessive sick calls. These co-pays would not be enforced for patients who are indigent, suffer from chronic diseases, need emergency care, have suffered work-related injuries, or are seeking staff-ordered care. They are easiest to enact if the prison has an in-house bank or canteen system, which would expedite payment and minimize transaction costs. According to the authors, these programs are strongly discouraged by the National Commission on Correctional Health Care (NCCHC), as they are concerned they can deter patients from seeking care to avoid payment. Fourth, some prisons have implemented pharmacies where inmates can purchase over the counter (OTC) drugs, in lieu of seeking medical attention. This recommendation is moderately supported by the NCCHC, although there are concerns that patients may misdiagnose themselves, delay treatment, or suffer from interaction effects between the OTC drugs and other drugs they are currently taking. Finally, prisons could expand or modify their utilization management programs. These programs are used to evaluate the appropriateness, medical efficiency, and need of health care services provided against an established set of guidelines.

The researchers were limited in their data collection due to lack of a centralized database, standardized metrics, and benchmarks for comparing programs. Currently there is no list of “best practices” for prisons, and these programs are implemented on an ad hoc basis. The researchers conclude there is no “one-size fits all solution,” and that more research needs to be done to determine which cost saving strategies provide the most effective results.

 Feature Photo: cc/(Tim Pearce)