Delivery of healthcare in prisons

1. Legal reasons for the rise in healthcare cost

The rise in the cost of health services is a consequence of the legal right to adequate healthcare for every inmate. Notably, the number of inmates in the U.S has been increasing over the years. Some reasons include the legal framework that has continuously put more people into prison than are released. According to Harte & Heavey (2017), the increasing rate of incarceration is attributed to strict legal actions towards drug crimes, which have admitted most inmates. Notably, the Trump administration launched a tough war against drugs as one of the ways of keeping America safe. Also, violent crimes account for most inmates serving long jail terms (Committee on Causes and Consequences of High Rates of Incarceration., 2014, p. 68). According to Harte & Heavey (2017), Trump administration has called for overall more stringent charges and more extended incarceration periods in support and enforcement of federal sentencing rules. Therefore, the increase in the number of inmates results in an increased demand for health care, hence increased cost

• Ethical reasons for the rise in healthcare cost

Ethical reasons that contribute to the increase in the cost of healthcare budget are treatment services and the prison system issues. There is increased concern about the quality of treatment offered in correctional facilities, with most stakeholders recommending sophisticated healthcare programs (U. S. Department of Health and Human Services, 2013). The recommended healthcare system is concerned about all healthcare issues of inmates to ensure their wellness. Besides, the system has additional components such as counseling, therapies, and education, which adds to the total cost of healthcare budget (U. S. Department of Health and Human Services, 2013). Also, the correction facility must have qualified healthcare professionals as required by the Medical Ethics declaration of the United Nations in 2006 (Pont, n.d.). The correction facility must ensure the training of all inmates concerning their ethical rights and standard. Due to these ethical requirements in correction facilities, the cost of healthcare inflates the budget.

• Categories of inmates causing increased healthcare budget

Older inmates and those with prevalent illnesses are the major drivers of healthcare costs. Notably, the more attention an inmate is given regarding health, the more healthcare cost the facility incurs. Studies have shown that in the united states, “federal prisons, state prisons, and local jails, 38.5% (SE = 2.2%), 42.8% (SE = 1.1%), and 38.7% (SE = 0.7%), respectively, suffered a chronic medical condition” (Wilper et al., 2009). Though the study mostly focusses on the prevalence of chronic diseases, the number of ill inmates at a given time in the United States prisons is significant to increase the healthcare cost. Some surfer from communicable and non-communicable diseases, while others suffer from conditions such as mental illnesses. Besides, the number of old inmates as of 2017 was about 200,000 (Reese, 2019). While the compassionate release policy helps in reducing the number of inmates, the number of adults above the age of 55 remains high in the U.S. Hence, both elderly and sick inmates have caused the increase in the value of healthcare budget.

• How the two categories lead to an increase in health services budget

Concerning the older inmates, they are susceptible to medical and mental illnesses. Such include dementia, loss of vision, dementia, and immobility, among others (Schiff et al., 2014). According to the report, older inmates require increased attention from healthcare professionals, special housing, which creates additional health expenditure for the correction facility. Also, the inmates tend to approach the old age and suffer the conditions mentioned above faster than their outside prison due to inadequate primary care and stress. The National Institute of Corrections reports that older inmates have, on average, two to three times higher health services expenditure compared to the other inmates (Kyckelhahn, 2014).

In the same way, sick inmates increase the health services budget. The higher the number of sick inmates, the higher the medical expenditure spend by the facility. That is, the management is compelled to hire more healthcare professionals, procure more medical supplies, and incur transport costs related to treatments. Transport is incurred by both patients as they are taken to medical facilities for treatment, or by health practitioners to the prison. Notably, the healthcare cost for inmates is higher than for ordinary citizens since they are not covered by Medicaid (“Health coverage options for incarcerated people,” n.d.).

• Improvements to the delivery of healthcare

The increased funding in the Health Services Budget will enable the facility to reduce illnesses. The most challenging health issues for all categories of inmates include behavioral diseases, infectious diseases, and injuries. The following improvements will be funded by the health services budget.

1. The funds will facilitate the hiring of more social workers to help inmates in overcoming their mental illnesses and substance disorders. Notably, most inmates suffer from stress and related mental illnesses. Such will include psychologists and psychiatrists. The budget will also facilitate therapy sessions.
2. Increase in sessions for therapies and primary health care within the facility. It is a collective intervention towards increasing the state of health among inmates. The budgeted funds will enable setting up a therapy room where a group or individual sessions may be conducted.
3. The funds will aid the introduction of a modified therapeutic approach, which will be undertaken by a collaboration between prison staff and the community to improve the mental health of inmates. The approach will include psychology experts and organized events to implement.
4. Increase the testing capabilities of infectious diseases such as HIV, STI, and hepatitis. A rigorous testing culture will help in spreading awareness and reducing infection cases within the facility. Concerning the tests that may not be possible to test at the facility, concerned inmates will be relocated to relevant health facilities to undergo testing or treatment.
5. The budget will aid in setting up advanced geriatric and end-of-life care. The old inmates require special care in healthcare and ethical perspective since they are most susceptible to diseases and psychological disorders. Therefore, old age caregivers will is procured from the health services funds. Improved facilities for the old age will be set up to improve the conditions of their sentence.
6. The facility will hire more educators to impact the attitudes, knowledge, and behaviors of inmates regarding healthcare. The budget will cater for the hiring and transport of the educators. In some instances, the fund will cover all educational materials that will be required to improve the health status if the facility.

References

Committee on Causes and Consequences of High Rates of Incarceration. (2014). Growth of Incarceration in the United States. National Academies Press.

Harte, J., & Heavey, S. (2017). U.S. Justice Department orders tougher criminal punishments. Retrieved 3 May 2020, from https://www.reuters.com/article/usa-crime-sentencing-idUSKBN1881KO

Health coverage options for incarcerated people. Retrieved 3 May 2020, from https://www.healthcare.gov/incarcerated-people/

Kyckelhahn, T. (2014). State Corrections Expenditures, FY 1982-2010. Retrieved 3 May 2020, from https://www.bjs.gov/content/pub/pdf/scefy8210.pdf

Pont, J. Medical Ethics in Prison. UNODC. Retrieved from https://www.unodc.org/documents/balticstates/EventsPresentations/FinalConf_24-25Mar11/Pont_25_March.pdf

Reese, H. (2019). What Should We Do about Our Aging Prison Population? | JSTOR Daily. Retrieved 3 May 2020, from https://daily.jstor.org/what-should-we-do-about-our-aging-prison-population/

Schiff, M., Bell, E., Chao, S., Choudhry, K., Huh, K., & McKillop, M. (2014). State Prison Health Care Spending: An Examination. Retrieved 3 May 2020, from https://nicic.gov/state-prison-health-care-spending-examination

U. S. Department Of Health And Human ervices. (2013). Substance abuse treatment for adults in the criminal justice system. [Place of publication not identified]: Lulu Com.

Wilper, A., Woolhandler, S., Boyd, J., Lasser, K., McCormick, D., Bor, D., & Himmelstein, D. (2009). The Health and Health Care of US Prisoners: Results of a Nationwide Survey. American Journal Of Public Health, 99(4), 666-672. doi: 10.2105/ajph.2008.144279