Why health care for prisoners could lower costs

About two in five prisoners have a chronic medical condition (often first diagnosed in prison) and more than seven in 10 prisoners of state systems need substance abuse treatment. But four in five prisoners don't have health insurance when they leave and return to society. (Credit: Haley C/Flickr)

More than 95 percent of prisoners will return to the community, often carrying significant health burdens and associated costs with them.

In a new study, researchers outline ways to improve health care for prisoners, both during and after incarceration.


“The general public doesn’t pay attention to what’s going on behind bars,” says lead author Josiah Rich, professor of medicine and epidemiology at Brown University and director of the Center for Prisoner Health and Human Rights at the Miriam Hospital. “But this is very important if you are concerned about the health of our population and health care costs.”

About two in five prisoners have a chronic medical condition (often first diagnosed in prison) and more than seven in 10 prisoners of state systems need substance abuse treatment. In fact, the illness of addiction is what lands many people in prison in the first place.

But four in five prisoners don’t have health insurance when they leave.

“Prisons and jails are necessary for the protection of society,” the study authors write. “For decades, though, the US health and criminal justice systems have operated in a vicious cycle that in essence punishes illness and poverty in ways that, in turn, generate further illness and poverty.”

Vicious to virtuous

Within that bleak situation, however, lies opportunity because incarceration allows for diagnosis and delivery of care that, if continued in the community, would reduce the onslaught of health problems for individuals and ensuing costs for society, Rich says. The authors’ recommendations are meant to turn that vicious cycle into a virtuous one.

The primary recommendation is to find alternatives to imprisonment when possible, given that the United States incarcerated more than 2.3 million of its 313 million residents in 2012. While the authors divided the rest of the recommendations between health care in prison and after release, in many cases the ideas are meant to improve integration of care between the two settings. Specifically they make the following recommendations.

In prison:

  • Improved oversight and accountability of prison health care, including making accreditation of prison health care mandatory and enforceable
  • Inclusion of prisoners in accountable care organization health plans to increase provider incentives for providing good care
  • Medical profession advocacy for legislation and programs that would benefit prisoner health, such as programs that improve care as prisoners transition to the community.

After release:

  • Employment of a “risk-needs-responsivity” model to triage prisoners, based on their personal history, to the most appropriate care
  • Assistance for released prisoners to help them enroll in Medicaid as it expands under the Affordable Care Act. In recent research, Rich has found that this activity may already be underway
  • Policies requiring electronic health records from within prison be available to community health providers
  • Incentives for community providers to deliver mental health care to released prisoners
  • Improved cultural competence among community physicians to understand the specific medical needs and risk factors of released prisoners. Transition Clinic medical homes provide a worthwhile example.

The full study and recommendations are published in the journal Health Affairs.

Source: Brown University