Talk about skin in the game! In this case, it's more like muscle and bone.
At least 38 states are charging prison inmates co-payments for healthcare services, according to a recent study by the Brennan Center for Justice at New York University School of Law (PDF).
Those fees typically are $20 or less, according to a story on the study by Stateline. But in Texas, state prison inmates who request a medical visit can be charged $100. In Utah state prison, inmates can be charged up to $2,000 for a hospitalization.
“We do it for the same reason your insurance company does, to eliminate abuse by making the inmates put a little skin in the game,” Tommy Thompson, jail administrator at the Rutherford County Sheriff's Office in Tennessee, told Stateline.
Charging co-pays teaches prisoners lessons about budgeting money, which will be valuable when they are released, said Chris Gautz, a spokesman for the Michigan Department of Corrections, which collects about $190,000 a year in medical fees from prisoners.
Jails and prisons typically deduct the medical fees from inmates' commissary funds, which include money earned in prison jobs. Most inmates earn less than $50 a month in such jobs. They use the money to buy supplies such as snacks, toothpaste and soap.
The co-pays “may not seem like a lot of money, but typically the prisoners are impoverished and often so are their families,” Dr. Robert Greifinger, an adjunct professor of health and criminal justice at the John Jay College of Criminal Justice and former chief medical officer of the New York Department of Corrections, told Stateline. “Sometimes their choices come down to a medical appointment or shampoo.”
It's estimated that states spent about $7.7 billion on prison healthcare in 2011, according to Pew Charitable Trusts. But experts say there are major shortcomings in the quality of healthcare for inmates in prisons and jails, given that per capita spending is limited. Much of the care has been outsourced to correctional healthcare firms such as Corizon, which has faced numerous lawsuits over the quality of care it provides and has lost a number of state prison contracts in the past several years.
“The quality of healthcare in prisons is pretty abysmal,” Brenda Smith, a professor at the Washington College of Law at American University, told Modern Healthcare in 2013.
On top of these quality of care issues, inmates face the challenge of being able to afford their co-pays. Prisoners have higher rates of infectious disease, chronic conditions, mental illness, and alcohol and substance-abuse problems, and nearly 10% of prisoners are 55 or older. Greifinger noted that inmates don't have the ability to go to the corner drugstore and buy over-the-counter remedies for minor illnesses or injuries. Instead, they have to get an appointment with the prison doctor or nurse and shell out a co-pay.
Even for Americans who are not behind bars, many top healthcare executives we interview at Modern Healthcare do not think highly of the growing deductibles and other cost-sharing that insurers and employers are imposing. “High deductibles are a concern because you end up with patients dragging out care that really needs to be provided, and their condition gets more and more serious,” Kaiser Permanente chairman and CEO Bernard Tyson said in an interview this spring.
That seems counterproductive for state and local governments, which logically have an incentive to keep their inmates healthy and avoid high costs for treating more serious illness. “If we have decided preventive care is a good idea, why corrections systems would do anything to limit access is a little bit puzzling to me,” Steve Rosenberg, president of Community Oriented Correctional Health Services, told Stateline.