Friday, August 2, 2019

Prison health care declines as aging prisoners' health needs increase

Prison is no place to get sick. The nation’s incarcerated population is aging rapidly, with nearly four times as many inmates 55 or over as there were at the start of this century, reported Governing. That’s led to increased rates of diabetes and heart disease, among many other problems. Younger offenders are hardly the picture of health, given their high rates of addiction. Altogether, prisoners make up 1 percent of the population, yet they account for 35 percent of the nation’s total cases of hepatitis C. “They are the most expensive segment of the population,” says Marc Stern, a public health professor at the University of Washington, “and they are the sickest.”
States often pay private health care providers on a per-inmate, per-day basis. That creates an incentive to cut costs. The market forces that discipline private providers on the outside, however, don’t apply in prison. There is no consumer choice. An inmate who doesn’t think medical treatment is up to par can’t switch to another prison, let alone a different hospital. And if the state, not the prisoner, is the customer, state officials don’t always know what they’re getting. Record-keeping is notoriously poor, and in some states, the department of corrections doesn’t even receive annual reports from its vendors.
When prison health care was first privatized in a major way, there was little reliable actuarial data, so it wasn’t clear what a reasonable price structure would look like. Over time, governments figured that information out and started writing better contracts, but that led to shrinking profit margins for vendors.
There have been other stresses on the business model. What was a growth area a decade ago is now stagnant. The state systems and large jails that are likely to privatize have already done so. With few new contracts out for bidding, providers low-ball one another in order to get business. That leaves yet less money available for care.
Some argue that prison health would improve if it were treated as part of the local community health safety net system. Communities are not immune to what happens inside their prisons, whether it’s opioid addiction or infectious disease. But most taxpayers on the outside don’t see prison health problems affecting their own well-being. The reality may be that treatment for those people society wants to punish will never become a top priority.
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