Whether an avid viewer of Orange is the New Black or long-time follower of the correctional system’s budget woes, people are more curious than ever about how healthcare works behind bars. Even if you’re not headed to the hoosegow any time soon, health care in prison is a topic worth understanding. Not only is correctional medicine an issue that should be on every taxpayer’s mind, but the financial state of free-world health care has made certain aspects of correctional health potentially worth replicating on the outside.
“In terms of efficiencies in correctional medicine that can be readily translated to free world medicine, I think they exist but I don’t think you’re going to like them,” says Dr. David Thomas, the chair of the Division of Correctional Medicine at Nova Southeastern University.
An Aging Population
Every year the Department of Justice must report their top 10 management and performance challenges and every year since 2006, it has included the housing of a growing and aging prison population on that list. Although there are many facets to this problem, health care is a big one.
So what’s it really like being a patient in the correctional medicine system?
According to the National Institute of Corrections (NIC), the yearly incarceration cost of an elderly inmate is about twice as much as that of a younger one. On average, that comes to about $64,000 a year versus $32,000 per inmate, and much of this cost disparity comes from differences in physical and mental health care needs.
So what’s it really like being a patient in the correctional medicine system? According to Dr. Thomas, it depends on how long you stay. If you’re stay is short, you probably won’t notice much of a difference in your care; but if you’re in for a longer haul, you’ll have a much more regimented experience. Days begin with a physical exam and the medical staff administers treatment for any chronic disorders, like diabetes, heart disease, or cancer. If you have a chronic disorder, you will also probably have a standing check up every three months.
Where prisons excel: medication adherence
Both appointments and medications are mandatory unless prisoners sign a release or are witnessed by a prison official refusing treatment. This arrangement can increase medication compliance to the point that some people are worried that the comparative drop off in medication use upon release could be dangerous. In the case of HIV drugs, to which patients can become resistant if they stop taking them, some people have even suggested that prisoners not be treated.
Every person in a correctional facility has a constitutional right to medical care.
Other big differences between free world and correctional health care include the necessity to provide care, and the limitations of the care available. Every person in a correctional facility has a constitutional right to medical care. That means they have the right to the opinion of a medical professional, access to that opinion, and care resulting from that opinion. However, prisoners are not guaranteed unnecessary medical treatments, such as cosmetic surgeries.
In addition, if a prisoner is seeking care in a non-emergency situation, they don’t just call up and make an appointment. Instead, they must submit a formal request for care.
…the physiological age of inmates 50 and older is, on average, 10 to 15 years more than their chronological age…
In many cases, the health of inmates improves in prison, Thomas said. Much of this has to do with the fact that their health may not have been a top priority for them in the free world where other concerns, such as food, housing, and money take precedence.
“Compared to the life that they lived, for most inmates, a prison is a safe, secure environment,” says Thomas.
The NIC found that the physiological age of inmates 50 and older is, on average, 10 to 15 years more than their chronological age, probably due to a tough pre-prison life. That means a 50-year-old inmate likely has the health issues of someone 60 or 65. Even with cost savings from a highly regimented health system, correctional facilities start out at a pricey disadvantage.
What prisons can learn from the free world
Some prisons are also taking cues from the free world to reign in their costs. Increasingly, correctional facilities are charging inmates co-pays for medications and doctor’s appointments. While this cuts down on costs, it can be a hefty price for prisoners who often make less than $20 a month.
“One of the best ways to save money in a medical care system – any system – is to do excellent primary care.”
There seems to be a certain expectation in society that health care in prisons is either extremely poor or far more than what that population deserves. In truth, each prison and jail is vastly different. Some of the best systems likely have programs and procedures in place that the free world could learn from, whereas others are in dire need of restructuring. In the end, if you want to understand prison health care, it’s important to realize how different the population there is from the outside world. Not only are inmates captive and tightly controlled, they are often a less healthy group than the general populous.
There is, however, one lesson Dr. Thomas said that the rest of the world could definitely learn from correctional medicine. “One of the best ways to save money in a medical care system – any system – is to do excellent primary care,” says Thomas. Even with all of the intricacies and particulars of correctional medicine, this mantra, which seems almost universal amongst medical professionals, still holds true.