Health care behind bars: A growing challenge for corrections leaders

Correctional institutions are faced with being the sole health care provider for the nation’s most ill people with the least amount of financial resources


Some of the sickest people are housed in the United States correctional system. Over the last decade the medical care provided to the incarcerated population has been considered substandard and lawsuits alleging inadequate care are frequent. Since health care typically makes up 9 to 30 percent of corrections budgets, it is no surprise that correctional  and state administrators are seeking ideas for cost containment while simultaneously trying to address improved quality of care.  

Key differences

Administering healthcare to the incarcerated population is no simple task. The socioeconomic and health differences between the incarcerated and nonincarcerated is dramatic. Hepatitis C is nine to 10 times more prevalent among the jail population. Chronic health conditions such as asthma and mental health disorders affect jail populations at much higher rates than the general population.

In this June 25, 2013 file photo , David Culberson, chief executive officer of San Joaquin General Hospital, looks over one of the patient care rooms while touring the new California Correctional Health Care Facility in Stockton, Calif. (AP Photo/Rich Pedroncelli, File)
In this June 25, 2013 file photo , David Culberson, chief executive officer of San Joaquin General Hospital, looks over one of the patient care rooms while touring the new California Correctional Health Care Facility in Stockton, Calif. (AP Photo/Rich Pedroncelli, File)

Incarcerated individuals are usually not under regular medical care for their chronic conditions and are simultaneously affected by homelessness, lack of insurance and low income. The jail population typically share other characteristics such as drug dependence and infectious disease. These high risk individuals arrive into custody, undiagnosed and untreated both for their physical and mental illnesses while medical staff must render  immediate, thorough and sufficient care.

Screening

Screening protocols are different for every facility. Screening procedures for infectious diseases vary for each institution and in every state across the U.S. Some HIV screening is offered in both jail and state correctional institutions, but not all. There seems to be a consistent screening upon intake for tuberculosis and syphilis but most fail to offer routine screening.

A common thread of weakness in the jail health care program is the process for obtaining outside diagnostic testing.  Finding the means to facilitate the transport and security of an inmate to obtain a needed MRI or biopsy at an outside hospital or lab can be quite complicated. The negotiations for such an undertaking can take extensive time and typically add  costs to more than just one budget.

Chronic health conditions

Chronic health conditions including asthma and hypertension account for a large proportion of correctional health treatments. The older inmate coupled with the ongoing obesity epidemic in the U.S. means nearly 40 percent of all inmates will have one chronic condition requiring treatment upon arrival into custody.

Infectious disease

HIV, Hepatitis C, sexually transmitted diseases and tuberculosis are highly contagious and rampant in jail populations. In 2002, the prevalence of TB in the incarcerated population was estimated between 4 and 17 percent higher than compared to the general population. Due to enclosed, poorly ventilated facilities with densely populated dayrooms TB infections spread easily.  In recent years, the spread of TB has declined, however the consistent rates of chlamydia and syphilis are still higher in correctional populations than the general public.

Older population

Between 1990 and 2012 the number of incarcerated individuals ages 55 and older increased by 550 percent. Older inmates have higher rates of dementia or cognitive impairments and geriatric syndromes.  The fact is that jail facilities were designed to house a younger population. Which means caring for the geriatric population with nursing home level care was not a consideration in functional design.

Correctional institutions are faced with being the sole health care provider for the nation’s most ill people with the least amount of financial resources. Correctional spending is considered the fastest growing government category next to Medicaid. Although there is debate as to whether outsourcing the medical care of correctional facilities actually cuts costs and improves quality of care, 32 states have already incorporated outsourcing to private vendors into their plans for provision of all or part of their correctional facility health care. By 2005, 40 percent of all correctional facility health care in the U.S. was being administered by for-profit, private correctional healthcare companies. Only time will tell if these moves will address the challenge of providing quality medical care behind bars.

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