The Cost of Health Care in Prisons Kills the Taxpayer

Correctional Health Care 

The cost of health care for correction facilities has been on the rise for years which continue putting pressure on almost all States’ budgets. The Supreme Court made a ruling in 1976 that all prisoners must be able to access medical care at the appropriate level and on time, and be diagnosed and treated by a physician without deliberate indifference to serious medical needs (Musick, & Gunsaulus-Musick, 2017). It is believed that inmates who receive effective treatment on mental and physical illnesses, including disorders caused by substance use will improve their well-being, which will reduce the likelihood of them committing new crimes or violating probation once they are released. The Court ruled that inmates are part of the country’s population; therefore, they have the right to medical care like any other citizen. Since then, the healthcare budget for prisons has been on the rise mostly caused by the increase in the number of inmates and also by the rise in the number of aging inmates. This essay will be based on the survey that was conducted by Pew in partnership with the Vera Institute of Justice.

It has been noted that most States are struggling to keep up with this rise in medical care for prisoners as it is strangling their budget. Prison medical care is viewed by many as a burden because it does not add any value to the community or contribute positively to the growth of revenue. States have developed different strategies to reduce this cost, but they still face the challenge of the aging prison population. The aging population requires more money to meet their medical care because they are more susceptible to infections, and these will continue increasing the cost. Therefore, both the States and the federal government are required to develop new measures that will help in reducing this cost such as releasing older prisoners.

Spending Treads and their Distribution 

In 2011 fiscal, all state spent a total of $7.7 billion on catering for correctional health care which was about a fifth of the prisons’ total expenditure (Psick, et al, 2017). Since 1990, the prison population countrywide had double up to 1.6 million inmates in 2009 when it reached its peak (Bedard, Metzger, & Williams, 2016). This increase in population had continuously increased the amount of money the government use on them especially through health care. It is recorded that during the 2009 peak, the states used a total of $ 8.2 billion to cater for inmates’ medical care only (Bedard, Metzger, & Williams, 2016). It is estimated that total annual prison spending increased by over tenfold from 1976, when the Supreme Court ruled that inmates should be provided with standards medical care, to 2011. This data indicates that medical care is one of the top spending’s in the prison expenditures. Although the total spending has declined since 2009, per-inmate expenditure has increased over the years mostly caused by the aging prison population (Psick, et al, 2017).

Correctional health care spending is broken down into major components to give a clear picture of how much money each division use. These components include administration, dental care, medical care, pharmaceuticals, mental health care, and substance abuse treatment. Each component requires a certain amount of money which helps the relevant authorities in budgeting and distributing the money. Medical care, which comprises of doctors, nurses, physician assistants, and medical supplies, take the lion share of the total amount followed by off-site and on-site hospitalization, then pharmaceuticals and mental health care close the top five spenders. Information on how much each component use is important to policymakers because this data helps them in making changes that could lower the cost used for prison health care. This information is also critical in establishing the health trends in prisons, if one component spending increases, it will help those involved to find alternative ways that would contribute in reducing capital used without reducing the health quality of the inmates.

Spending Drivers 

The inmate populations’ size, age, and health status are the primary determinants of total correctional health care spending. Increase to the total health care spending is also influenced by several factors which include; the distance between correction facilities and hospitals or other providers, an aging inmate population, and the prevalence of chronic and infectious diseases, mental illness, and substance use disorders among inmates. From 2001 to 2008 the prison population grew from 1.34 million to 1.54 million which was a 15 percent increase (Bedard, Metzger, & Williams, 2016). The increase caused the correctional health care spending to grow significantly within that period. Due to this increase, many states began reviewing and modifying their corrections and sentencing policies to reduce the pressure that was building up in prisons. This move led to the release of prisoners who had fewer charges and those who were almost completing their sentence. By 2011, most states had reduced the number of inmates in their prisons, and this reduced the amount of money used for inmates’ health care (Maschi, et al, 2016).

Location, Staffing, and Inmate Transportation 

Prisons that are located far from population centers use more money in health care. Most medical professional like to work in population centers so prisons situated far from these centers will have to provide compensation higher than the average to attract and retain medical staffs. These prisons often fall short in recruiting the required number of medical staffs which force them to consider overtime and temporary workers, which on many occasions exceed the cost budgeted for this work. The cost is also pushed up when inmates are required to travel long distances to see specialists or stay overnight in hospitals. The cost is pushed up because the inmates must be guarded all through and they must have special transportation, which according to the Legislative Analyst’s Office in California, the cost for one inmate can exceed $2000 per day (Maschi, et al, 2016).

Prevalence of Disease and Mental Illness 

The study shows that inmates have a higher incidence of chronic and infectious diseases, such as hepatitis C and AIDS, and mental illness when compared to the general population. Also, a large number of inmates receive treatment for substance disorder such as alcohol and drug use. This kind of treatment is common in all prisons because most inmates were engaged in the use of these substances before they were sentenced. In 2010, roughly a third of inmates in all prison suffered from mental illness while a quarter of them experienced a co-occurring mental illness and substance use disorder (Weiss, 2015). Some reports indicate that an average $87 million is used annually in the treatment of mentally ill inmates in the jail system only without including federal or state prisons (Bedard, Metzger, & Williams, 2016).

The infection of Hepatitis C among inmates continue to rise each year and have reached an epidemic level with 17.4 percent of prisoners having it in 2006 (Weiss, 2015). 90 percent of patients are cured using Harvoni and Sovaldi drugs which cost around $90000 per patient (Weiss, 2015). This means as the number of infected inmates continues to rise, it will increase the amount required for correctional health care. HIV/AIDS also use a lot of money to treat and care for infected inmates. The Bureau of Justice Statistics reported that federal and state prisons inmates infected with HIV are between 1.2 to 1.9 percent of the total population (Weiss, 2015). The prisons use “cocktail” which is a very expensive and potent drug which is also known as HAART. According to a report released by the Center for Disease Control and Prevention in 2017, estimates that treating one AIDS patient using this drug cost around $1863 per month or $22356 per year (Bedard, Metzger, & Williams, 2016).

Older Prisoners, Great Expense 

As people get older, their health care costs increase, and it is no exception for the prison population who also follows the same suit. Older inmates have been found to be more susceptible to chronic diseases and mental conditions such as; impaired mobility, dementia, and loss of vision and hearing. Experts in medical fields say that inmates are likely to age sooner than the population outside the prison because of matters such as inadequate preventive and prime care prior to incarceration, substance use disorder, stress caused by isolation and sometimes the violent environment they experience in their life in prison. A prisoner is classified under the group of older inmates if he or she is at the age of 55 and above (Musick, & Gunsaulus-Musick, 2017). The number of older inmates in state and federal prisons increased significantly from 1999 to 2012. Statistics show that the number rose from 43300 to 131500 which is a 204 percent increase (Psick, et al, 2017). The increase has a big impact on prison budget because they increase the amount needed to take care of their health because they are highly susceptible to chronic and terminal illness.

The National Institute of Corrections estimated that prisoners above the age of 55 require two to three time the expense of other inmates on health care although recently, some researchers have found that the differential in this cost may be wider than that (Psick, et al, 2017). From the survey that was done by Pew, it shows that the states with a high number of old inmates, the health care per inmate is higher than in the other states. Therefore, these states use more money on correctional health care for a population that is not benefiting the community in any way thus reducing the income of that state. Aging prison population will continue increasing the health care spending, and it is the high time for the policymakers to find a way of how they will deal with this aging population of prisoners.

Cost-Containment Strategies 

Correction officials are looking for a way to reduce the expense of health care without surrendering the quality of care or public safety. Some of these strategies include; enrolling prisoners in Medicaid, outsourcing prison health care, using telehealth technologies, and paroling older and/or ill inmates. Telehealth is the use of telecommunication and electronic information to support long-distance health care services. The states are looking for outside partners who will provide health care services to their prisons at lower costs and maintain the quality of care. Some states are also enrolling eligible prisoners in Medicaid so that they can cover at least 50 percent of prisoner’s inpatient hospitalization (Weiss, 2015). Lastly, states are releasing terminally ill, older, or incapacitated inmates who meet specific requirements in a move to their expenses.

In conclusion, increase in correctional health care spending is posing a financial challenge to state policymakers because it is straining their budget. The strain is mostly passed down to the citizens through taxation. The threat is predicted to continue with the increase of older inmates in the prison population. To solve this problem, the lawmakers should develop policies that will favor the reduction in the amount required for correctional health care such as, short sentences for those with fewer offenses, and releasing prisoners who have stayed for long but have met certain requirements that will help them be released back to the society. Correction officials should move forward into using telehealth, Medicaid financing for eligible inmates, outsourcing care, and using appropriately geriatric or medical parole, and any other strategy that will help them reduce health care spending without altering the quality of the care.

References

Bedard, R., Metzger, L., & Williams, B. (2016). Ageing prisoners: An introduction to geriatric health-care challenges in correctional facilities. International Review of the Red Cross , 98 (903), 917-939.

Maschi, T., Leibowitz, G., Rees, J., & Pappacena, L. (2016). Analysis of US compassionate and geriatric release laws: applying a human rights framework to global prison health. Journal of Human Rights and Social Work , 1 (4), 165-174.

Musick, D., & Gunsaulus-Musick, K. (2017). American Prisons: Their Past, Present and Future . Routledge.

Psick, Z., Simon, J., Brown, R., & Ahalt, C. (2017). Older and incarcerated: policy implications of aging prison populations. International journal of prisoner health , 13 (1), 57-63.

Weiss, D. (2015). Privatization and Its Discontents: The Troubling Record of Privatized Prison Health Care. U. Colo. L. Rev. , 86 , 725.