Increasing Cost of Inmate Health Care in U.S

Abstract

Jail and prison inmates experience disproportionately high levels of chronic and acute physical health problems, resulting in increased utilization of health services in correctional institutions. Variations in both health status and health care utilization are likely, although several important factors have been under-researched. The current study explores the “get tough" policy and how it is affecting the health care system in prisons. Using multiple regression analysis, predictors of prisoners, utilization of medical care, and inmates' evaluations of the accessibility and quality of health care are identified. The results indicate that “get tough" policy is one of the factors which are affecting the health care system in prisons. The experience of incarceration also appears to influence the physical health of inmates, as self-reported health problems increase with inmates' duration of incarceration. The results suggest a need for medical care in correctional settings to adapt to the medical needs of older inmates and women, in addition to improving treatment for chronic conditions and preventive services in “get tough” conditions.

Table of Contents

Abstractii

Introduction1

Purpose of the Study2

Aims and Objectives2

Literature Review3

The Physical Health Status of Inmates3

Medical Care Utilization in Correctional Settings4

Evaluations of Correctional HealthCare Services4

Methodology5

Sample5

Measurement of Variables7

Independent Variables7

Physical Health Status8

Medical Care Utilization8

Evaluation of Medical Care9

Statistical Analysis10

Results10

Descriptive Statistics10

Multivariate Analyses12

Physical Health Status12

Medical Care Utilization13

Evaluation of Medical Services14

Summary of Results15

Discussion16

Physical Health Status16

Medical Care Utilization17

Limitations to the study18

Conclusions19

References21

Appendix24

Table 1:24

Table 2:24

Table 3:25

Table 4:25

Table 5:26

Table 6:26

Increasing Cost of Inmate Health Care in U.S

Introduction

Beginning in the late 1970s and continuing throughout the next two decades, the United States' reaction to escalating crime rates was to enact policy that was designed to be "get tough" policy.  Jail and prison inmates experience disproportionately high levels of both physical and mental symptomatology, including infectious diseases, chronic conditions, severe psychological disorders, and mild psychological symptomatology. Concern about the causes of such elevated morbidity has led researchers to consider at least three competing explanations for this phenomenon (Waitzkin, 1971).

First, it has been suggested that the disproportionately high levels of health problems are due to inmates' prior vulnerability to morbidity, since inmates are disproportionately members of the lower class, minority, less educated, and unemployed and such factors are closely associated with worsened physical and mental health in the general population. Thus, individuals possessing particular socioeconomic characteristics associated with poor physical health tend to be over-represented in prisons and jails (Marquart & Merianos, 1996). This is of particular concern in the latter since many, if not most, jail inmates are pretrial detainees whose economic circumstances preclude their release on bail. Alternatively, it is argued that features of correctional institutions have a major impact on the elevated morbidity among inmates. It is posited that jails and prisons contain severe stressors which threaten inmates' health. Factors such as violence, overcrowding, and isolation may have an impact on physical and mental healthproblems. Clearly, infectious conditions in particular are largely fueled by the communal living and overcrowding characteristic of most correctional institutions.

Given that the rate of over-crowding and intentional injury (homicide excepted) is greater in ...