Statistics show that today there are 1.5 million in prison and 0.7 million people in jail in this country. There are a number of challenges in delivering healthcare to a growing population of inmates that are an expensive group to maintain.
As Steve Rosenberg, President for Community Oriented Correctional Health Services pointed out, 2.2 million people generally young, non-white, poor, and mostly males spend time in prison. His talk took place at the August 1, 2014 Alliance for Health Reform briefing on Capitol Hill also supported by Centene, titled “Healthcare Behind Bars”.
One of the major challenges facing the prison system is dealing with all the inmates with mental health issues. Many of the inmates are depressed, schizophrenic, and bi-polar. Some exhibiting self-injurious behavior, may be dealing with substance abuse issues, or have a history of violence.
The prison population also contains many inmates not only with mental illness, but also the population contains prisoners with HIV, addiction disorders, conditions associated with aging, and many have Hepatitis C.
Rosenberg also reports that few individuals in correction facilities have health insurance and one study shows that 90 percent have no health insurance when released from jail. One study even shows that 80 percent of individuals in jail with chronic medical conditions did not receive treatment in the community prior to arrest.
According to the Pew Charitable Trust report “State Prison Health Care Spending” published in July, shows that spending in correction facilities is the second fastest growing state expenditure, behind Medicaid.
The Pew report examines the factors driving costs by analyzing new data on all 50 state prison healthcare spending from FY 2007 to 2011. The report also describes a variety of promising strategies that states are using to manage spending, including the use of telehealth technology, improved management of health service contractors, Medicaid financing, and medical or geriatric parole.
In an era of tight budgets and seeking new ways to maintain prisons, the Reason Foundation Policy Brief 122, “Public-Private Partnerships in Correctional Health Care” by Lauren Galik and Leonard Gilroy, states, “Only 14 state correctional healthcare systems are completely self-operated by government correctional agencies.”
The brief notes that today, 36 states contract out at least a portion of their correctional healthcare services to either a private company or their state university health system. Of the 36 states, 24 states have their state correctional health care systems run completely by private companies through comprehensive full scope Public Private Partnerships.
Six other states have contracted out some healthcare services but not necessarily to private firms. So far, contracted services range from comprehensive services, such as mental healthcare to specialized services, such as dialysis, and telemedicine.
Dr. Sharon Lewis, Statewide Medical Director for the Georgia Department of Corrections also speaking at the briefing said, “Georgia’s 120 facilities, has the 5th largest prison population with 55,000 offenders in prisons, 94 percent are male and 6 percent female, 62 percent are age 25 to 45 but 50 percent are older than 35. In addition, demographics show that 37 percent of the inmate population have a significant chronic illness and that 17 percent of the population receives mental health services.”
Dr. Lewis discussed the challenges Georgia faces. For example, the inmate population is “graying” which means there are inmates with more physical incapacities, immobility issues, plus progressive degenerative illnesses. Also, there are diminishing funds in the healthcare budget to care for the inmates which is resulting in increased liability.
Asher Turney, MD, State Medical Director, Centurion of Tennessee reports that Centurion uses an innovative managed care model within the state’s correctional setting. This includes using evidence-based treatment protocols, predictive modeling, preventive medicine, and taking care of the chronically ill.
Dr. Turney described how Centurion in less than one year has decreased emergency room and hospital admissions by improving the scope of services, installing telehealth across the state to obtain help for inmates much sooner, introduced on-site MRI and CT services thereby reducing the need to transport individuals off-site, and hired additional healthcare professionals for the facilities.
For more details, go to www.allhealth.org.