Every year, about 11 million people are booked into U.S. jails. The government running the jail—usually a county—has a constitutional mandate to provide inmates with necessary health care. Little is known about how jails administer their health care programs and whether these programs further public health and safety goals. Research is limited on how counties organize their jail health care services, what care they make available and when, and how they ensure they receive value for their investment in health care. The Pew Charitable Trusts reviewed 81 requests for proposals for contracted jail health care services and conducted in-depth case studies of three jurisdictions. The research found wide variation in the ways that counties provide health care in their jails and the information they supply to help vendors craft bids. There also were varying approaches to whether and how jails prepare individuals to manage their health once released.
Many jails contract with vendors to provide health care. In New York state, 84 percent use vendors to provide at least some health care services. The arrangements that counties make with providers vary; for example, one vendor may be responsible for all services, or a county can use multiple vendors across types of health care services such as mental health and dentistry. While some counties share financial risk for costly medical care with the contractor, others have their vendors assume all risk through a negotiated per-inmate, per-day rate. The portion of a jail’s budget spent on health care can vary widely by county. In Virginia, jails spend anywhere from 2.5 to 33 percent of their budgets on health care. Although most jails conduct bookings 24 hours a day, many do not have medical or nursing staff on site to screen incoming individuals at all times. This can lead to delays in identifying and treating acute, possibly life-threatening health problems, and missed opportunities to divert people into treatment settings rather than jail.