Experts say many states are struggling to provide an adequate level of healthcare services for incarcerated and justice-involved individuals. According to David Redemske, principal health planner at the healthcare architecture firm HDR, one reason for this disparity is the simple fact that prisons often have insufficient resources to deliver more efficient, coordinated care. He argues that states need to re-examine the kind of healthcare they are providing their prison populations in order to avoid public health crises once former inmates re-enter society.
Justice-Involved Population Health
According to the HDR report, on average, inmates tend to be poorer in health than the general population. Redemske explained that prison health systems lack the necessary coordination with community health providers to continue care for inmates once they are released.
"If we don't take care of these issues while they are incarcerated they are going to bring these issues right back to the community."
David Redemske, principal health planner, HDR
Risk factors among justice-involved populations include:
- The risk of infectious diseases being spread once prisoners re-enter communities if they have left prison with untreated or unmanaged illnesses, such as tuberculosis, HIV and hepatitis C.
- The possibility of increased strain put on community hospitals due to the growing rate of chronic conditions within the prison population, such as heart disease and cancer, if they are not properly managed by prison healthcare providers. Redemske suggests prisons should adopt more of a public health model that focuses on wellness, disease treatment and management, prevention, and creating a continuum of care during and after incarceration.
- There are three times more mentally ill people in prison than among the public that are receiving treatment.
- Most discharged inmates receive only a two-week supply of medication and no plan for follow-up care.
There are various concerns that arise when assessing inadequate care coordination between criminal justice systems and community health organizations:
- The inability to cope with the changing health needs of a prison population that is getting older. According to the U.S. Department of Justice, the number of inmates over the age of 55 increased 400% between 1993 and 2013 and currently more than 18% of prison inmates are over the age of 50.
- Accordingly, states have seen an increase in the number of individuals with chronic conditions, such as heart disease and cancer, also causing an increase in healthcare costs for inmates.
- States with higher per-inmate spending had higher percentages of older inmates. Federal prison medical costs increased from $905 million to $1.1 billion, a 22% jump, in just four years from 2010 to 2014.
- There are inconsistencies in health spending from state to state. The amount spent on corrections healthcare per inmate in California was $19,798 versus $2,173 in Louisiana in 2015.
A Path Forward for Correctional Health Care
Redemske conveys through the report that prison systems should seek more partnerships with public health and academic medical centers as means of providing support and continuity of care for inmates during and after their incarceration.
Substandard healthcare for prisoners is not an appropriate form of punishment or justifiable because they are inmates. "We need to change the dialogue between being tough or being soft on crime to being smart about it," Redemske said.
ACT.md customer NCHIIN, the North Coast Health Improvement and Information Network in Humboldt County, California, is expanding their use of transition and healthcare alerts within ACT.md's community health collaboration hub as they relate to jail, law enforcement, and probation. Case managers are aiming to connect justice-involved individuals with appropriate health and social services, preventing emergency department visits and de-escalating encounters with law enforcement.
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