Costs of Health Care in Correctional Facilities

Health services can make up anywhere from nine to thirty percent of corrections costs. There are several methods that prisons have tested to contain costs. Reducing both costs and demand for services have been studied, but the approaches of various correctional facilities in the US are very different.

Three important ways to reduce costs could be:

  1. implementing and expanding telemedicine. This can decrease costly and sometimes unsafe patient transportation and increase access to specialists.
  2.  implementing new technologies to decrease the time nurses spend dispensing medication. Automating many of these tasks could help decrease medical errors and improve quality of care.
  3. working with other facilities to increase their economies of scale, correctional facilities could raise their bargaining power and negotiate lower costs for medications with providers.

Currently, there is no singular list of “best practices” for correctional facilities; programs are implemented as needed. Researchers conclude there is no “one-size fits all solution,” and that additional research must occur to determine cost saving strategies that provide the most effective results.

Emre Umar

Income of Pre-Incarcerated People

As is likely expected, populations with criminal records generally have lower income than their counterparts. Incarcerated men had incomes about half of those of those who have never gone to prison. And this is controlled for age, reflecting men in the upper 20s to low 40s. Poor people are overrepresented greatly among incarcerated populations. And coming from poorer backgrounds, often these individuals have had little exposure to healthcare, and will have great difficulty finding employment, housing, and aid once released.

The Importance of Compassionate Care

Compassion can be defined as a sensitivity to distress together with the commitment, courage, and wisdom to do something about it. Patient outcomes are proven to improve when the spirit of compassion influences in all patient interactions.

Press Ganey has found six themes in compassionate care:

■ Acknowledge Suffering: We should acknowledge that our patients are suffering and show them that we understand.
■ Body Language Matters: Non-verbal communication skills are as important as the words we use.
■ Anxiety is Suffering: Anxiety and uncertainty are negative outcomes that must be addressed.
■ Coordinate Care: We should show patients that their care is coordinated and continuous, and that “we” are always there for them.
■ Caring Transcends Diagnosis: Real caring goes beyond delivery of medical interventions to the patient.
■ Autonomy Reduces Suffering: Autonomy helps preserve dignity for patients.

If empathy doesn’t come naturally to a health care provider, it can be taught. Coaching on patient interactions can make a big difference. Instead of making providers into something akin to healthcare machines, the goal should be to create people who can function as healthcare empaths.

Obviously, there are many competent providers for whom compassion may not be a natural component of their makeup. And providers, at the end of the day, are only human and can have their limits stretched, particularly in the difficult healthcare environment. But providing hope and support can only serve to make provider/patient interactions more productive.

A Look at Jails in Spain

The incarcerated population continued to decline in 2015, a total of 19% in five years. Penal Code reform in 2010, reducing the length of sentences for some crimes and the implementation of new, lesser sentences for road security-related crimes helped drop the number.

The Spanish penal system is divided into two administrations:

For autonomous communities in Spain, except Catalonia, the General Secretariat of Penitentiary Institutions under the supervision of the Ministry of Internal Affairs.
For Catalonia: the General Directorate of Penal Services, under the supervision of the Generalitat’s Department of Justice. A joint committee aids in coordinating the two administrations’ activities.

The 1978 Constitution abolishes the death penalty, except during wartime. The 1995 Act abolishes the death penalty at all times. The last executions took place in 1975 when two militants from the Euskadi Ta Askatasuna (ETA) were shot.

In 2014, the most recent year for which there are statistics, there were 28 suicides in Spanish correctional facilities.
Healthcare in Spanish prisons falls under the responsibility of the Minister of Internal Affairs.

A team of primary health care providers provides ambulatory care in the prisons. There are often not enough health care professionals (1 doctor per 1,200 prisoners).

Each prison is associated with a reference hospital, which must have a secured unit for patients.

According to a report released in 2014 from SGIP, 76% of the prisoners incarcerated this year took drugs the month prior to their incarceration. In risk reduction programmes, 6.9% of the prison population received methadone in 2014. Syringes and condoms are distributed to avoid the spread of HIV.

Therapeutic units, across the 42 penitentiary centers offer psychosocial support to inmates who are drug-addicts. However, access to therapeutic resources is limited. Help provided for drug addicts is mainly to serve as an alternative to imprisonment or as a follow-up workshop once the person is released, but not as a therapeutic and/or medical treatment.

The Spanish Society for Penitentiary Health (SESP) is pleading for penitentiary health to be attached to the Ministry of Health. This would facilitate the transfer of medical files and the coordination of health programmes. In Catalonia and the Basque Region, the jurisdiction of this service has been transferred to the Ministry of Health. In these two communities, the number of hospitalizations has decreased.

Spain’s general prison occupation rate is 91.8 prisoners by 100 places, while in the region of Catalonia that rate is a much higher 120.6, a 2013 Council of Europe report reveals. This compares to 96.6 percent occupancy in the UK.

Inmates Fighting Wildfires in California

The summer of 2018 has been a bad one for California wildfires, a common occurrence that this year has been out of hand. And as in years past, California is using inmate labor to assist in the fighting of these fires. While the practice is not without controversy, it has undoubtedly made a difference.

A common perception is that inmates are being forced into fighting fires. However, the truth is firefighter is a sought-after job for inmates, who have to pass testing and demonstrate long-term good behavior before being picked for the detail. Some inmates like the increased pay (although still very low by non-inmate standards) and some even say the food served in the camps is better, which is a nice perk. And some inmates say that despite the dangers the fires pose, it still feels safer than being in a prison facility with more hardened types who lack the motivation to do something like fight fires in the wilderness.

One downside is the experience these individuals gain from fighting fires is difficult to convert into a job when they are released back into society. Although studies have shown that inmates who gain a work skill while incarcerated are less likely to re-offend, if they don’t get past the interview process, it’s hard for those work skill programs to have their maximum impact. State officials do say however in the case of inmate firefighters, it isn’t actually meant to be a job training program. Rather, it is a way for them to earn time off their sentences: two days for each day served in the fire camps.