Despite the slowdown in prison healthcare costs, older inmates may prompt greater expenses in the near future.
State and federal prisoners age 55 or older increased 204% from 1999 to 2012, compared with a 9% increase of inmates younger than 55, as longer sentences continue to be served. Of 44 states that provided data on inmates' ages, all but two experienced a rise in older inmates from 2007 to 2011. And since inmates are already predisposed to higher rates of chronic and infectious conditions such as hepatitis C, it's likely state prison budgets will have to grow.
“States can expect to be spending more on chronic diseases for those individuals, even at an earlier age,” said Maria Schiff, director of the State Health Care Spending Project, a joint effort between Pew and the John D. and Catherine T. MacArthur Foundation.
Many states varied on average costs per inmate. For example, the amount California spent per prisoner on average in 2011 was $14,495, the most of any state. By contrast, Oklahoma spent only $2,558 on each inmate. Schiff attributed those variations, in part, to states with larger populations of older inmates and higher salaries for physicians in high-cost regions.
“The higher-standard-of-living states have to spend more for their clinicians than other states,” Schiff said. “There's just that fact of life.”
What the report wasn't able to track was healthcare outcomes. The highly lucrative prison healthcare industry, which is increasingly being outsourced to private contractors, has been criticized for a lack of oversight and inadequate care. As many inmates finish their sentences and return to their communities, Schiff said providing high-quality care for their mental illnesses, substance-abuse problems and chronic diseases should be viewed as an investment to avoid recidivism.
“It not only benefits the prison, but also has a public-health and public-safety advantage,” she said.
To keep costs contained in the future, the Pew analysis suggested prison systems continue to use telehealth for inmates who need primary-care services but don't necessarily have to travel off site.
“(Telehealth) really lends itself to prisons because of the rural nature of where they are, often, but also it cuts down on the transporting/guarding expenses,” Schiff said.
According to a sample of 10 states in the report that had complete spending data, 37% of prison healthcare services went toward general medical care—or care provided by physicians, nurses, physician assistants and other clinicians. Another 14% of spending went toward mental health, while 5% was used to treat substance abuse.
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