Pew Study Calls for Better Monitoring of Prison Health Care

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photo by Jorge Elías via flickr

The aging population of America’s prisons adds renewed urgency to efforts to provide continuing health care services to the hundreds of thousands of individuals who are released from state incarceration each year, according to Pew Charitable Trusts.

A nationwide Pew study released Wednesday found dramatic variation in the amount states spend per inmate on correctional health care—ranging from $2,173 in Louisiana to $19,796 in California in 2015—and concluded that a “seamless” approach to assist justice-involved individuals with their health needs during and after prison should be a critical goal for state policymakers and corrections administrators.

Effective post-prison health care programs can “slow down the revolving door from jail, to the streets, and back to jail,” the study said.

“At least 95 percent of those in state prisons eventually leave (and) more than half a million individuals do so in a typical year,” said the study. “So prisons and communities are constantly reintegrating returning residents, a disproportionate share of whom have a chronic disease, including a behavioral health condition or an infectious disease.

“Therefore, their prospects for a successful re-entry are affected by the seamlessness of their health care transition.”

The study noted that formerly incarcerated individuals as a group generally have more serious health care needs than the regular population, and added that statistics show that the share of older individuals in prison rose between 2010-2015 in all 44 states who participated in earlier studies by Pew and the Vera Institute of Justice.

Their needs on leaving prison were therefore often more critical, such as continuing treatment for addiction disorders and dementia.

“The time immediately following release is especially dangerous, even deadly,” Maria Schiff. Senior Officer on States Fiscal Health at Pew Charitable Trusts, and one of the authors of the study, said in a Webinar introducing Wednesday’s report.

She added that former incarcerees are especially vulnerable to drug overdoses, heart attacks, and complications of mental health that can lead some to suicide without continued post-prison treatment and counseling.

Some of the variations in state spending reflect the differences between the 30-plus states who accepted the expansion of Medicaid eligibility for justice-involved individuals provided under the Affordable Care Act of 2014 and those who didn’t.

The Ohio Department of Rehabilitation and Correction, for example registered a 9 percent decline in inflation-adjusted per-inmate spending fall by 9 percent from fiscal year 2013 to 2015, largely as a result of activating Medicaid coverage for prisoners.

The drop in hospital spending alone by more than half accounted for most of the decline.

But an assessment of prison and post-prison health care is complicated by the sharp differences between states in monitoring their systems, according to the study, which added the lack of federal requirements for collecting data on their correctional health care programs was a major stumbling block.

The study’s recommendations included establishing a legislative requirement at the state level to collect such data, and create effective, transparent and predictable reporting systems to ensure that effective correctional health care wasn’t subject to the yearly shifts in state budget allocations.

“Well-run, forward-thinking prison health care systems are vital to state aims of providing care to incarcerated individuals, protecting communities, strengthening public health, and spending money wisely,” said the study, the latest in a series of Pew reports analyzing trends in state correctional health care.

“Likewise, poorly performing systems threaten to make states less safe, less healthy, and less fiscally prudent.”

The study, based on data collected from two surveys in 2015 and 2016 administered by The Pew Charitable Trusts and the Vera Institute of Justice, along with interviews with more than 75 state officials, found that state departments of correction collectively spent $8.1 billion on prison health care services for incarcerated individuals during fiscal year 2015—which represented about a fifth of overall state prison expenditures.

The 2015 survey was completed by every state except New Hampshire, and the 2016 survey also lacked data from New Hampshire, as well as Kansas and Alabama.

The authors of the Pew study said monitoring and improving the cost-effectiveness—and quality— of the health services provided to prisoners and the formerly incarcerated should be high on the agenda of state legislatures.

“With nearly all incarcerated individuals eventually returning to society, treatment and discharge planning—especially for those with a substance use disorder, mental illness, or infectious disease—play an important role in statewide anti-recidivism and public health efforts,” the study said.

“Yet (state legislators and correctional administrators) often lack the information they require to build and maintain high-performing prison health care systems that proactively make the most of diagnostic and treatment opportunities and avert the harmful and expensive consequences of inattention or missteps.

“They need to know how much money is being spent on what services and why; what benefits are achieved for those dollars; and whether these benefits are preserved post-prison through well-coordinated prison-to-community transitions.”

Schiff said that helping states get their correctional health care systems “right,” was equally important to former prisoners and their families.”

“The stakes are high and failure is expensive to all of us,” she said.

The other authors of the report were Kil Huh (senior director), Alex Boucher, Frances McGaffey, and Matt McKillop.

The full study, entitled “Prison Health Care: Costs and Quality: How and Why States Strive for High-Performing Systems,” can be downloaded here.

This summary was prepared by Stephen Handelman, editor of The Crime Report, with the assistance of TCR news intern Megan Hadley. Readers’ comments are welcome.

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