Innovations Help Control Prison Health Costs


A prison inmate falls and hurts his knee during a rough-and-tumble basketball game. Prison medical workers examine him and decide he should see an orthopedist.

But instead of spending $200 to $1000 to transport the prisoner to an outside facility, medical staffers make a high tech appointment with the doctor, enabling the patient to see a specialist via telemedicine.

Episodes like this happen every day. Because people in jail have a constitutional right to quality health care, Texas, Ohio and most other states are relying on new medical technology and taking other steps, such as requiring inmate co-payments, to ease the cost burden on their taxpayers.

Brian Eastman, an Ohio corrections department budget officer, says an increase in the prison population in his state has caused the budget to "rise dramatically."

So use of telemedicine, which lets inmates see a doctor without leaving prison, helps control costs, he says. The state also requires inmates to pay a small fee for doctor visits.

Telemedicine works like this: when an inmate has an ailment that cannot be treated by prison medical staff, a specialist is contacted and an appointment is arranged. During the appointment, the prisoner and a healthcare professional hold a video-conference with the specialist. By talking with the patient and conducting an on-camera examination, the specialist is often able to diagnose or suggest a consultation.

"Savings are realized because there is no need to transport inmates who participate in telemedicine. These savings include actual transportation costs, as well as the cost of sending staff along to the appointment with the inmate," Eastman said.

Ohio is also experimenting with a co-pay system for prison health service. Charging a small fee theoretically curbs requests for unnecessary medical attention. Eastman says each inmate pays $3.00 for every trip to an off-campus doctor's office.

"It can become a day trip for prisoners; transferring them to different places. The whole idea is to make them think about it before they ask and this cuts down on transporting them 100 percent of the time," Eastman said.

Ohio had 19,720 inmates in 34 state-funded prisons in 2001 and spent an average of $6.71 per day for the healthcare of each, totaling $111,000.

In Texas, Larry Todd, director of public information for the department of criminal justice, says telemedical services provided through Texas Tech University have "certainly reduced costs."

"The system helps inmates keep regular appointments for non life-threatening concerns or immediate medical attention; it keeps them communicating with medical staff on a regular basis," Todd told

In 2002 the Texas department of criminal justice operated on a $2.6 billion budget and retained a prisoner population of 146,000. Under the operating budget, prisoners in 109 state prisons are budgeted to receive about $5.40 per day in healthcare.

"Telemedicine is a good alternative in the prison system because anytime you hire a doctor to come in or take a prisoner out and into the community, it becomes a big expense. If you can avert one of these trips, you save a big chunk of money," says Douglas McDonald, researcher at Abt Associates Inc., a policy research organization that dealt with telemedicine's influence in reducing medical costs.

States with large prison populations, like Texas, have gone farther than others to arrange telemedical services for their patients, McDonald says. "There hasn't been a big bang; telemedicine isn't happening all at once, but it is progressive," he says.

McDonald doesn't see the co-pay system as being an economic cost-saver for states.

"If prisoners are dissuaded to seek medical attention during the early stages, this could result in having to seek serious medical attention later for an acute or chronic condition," he says.

The Eighth Amendment to the U.S. Constitution obligates prison officials to provide prisoners with adequate medical care, a principle that "applies regardless of whether the medical care is provided by governmental employees or by private medical staff under contract with the government," the American Civil Liberties Union (ACLU) said in a 1999 report.

Kara Gotsch, a policy coordinator for the ACLU's national prison project, which works to protect prisoners rights through class action lawsuits, says telemedicine and co-payments for prisoners could cause problems. than necessary.

Gotsch says states must remember that a prisoner's access to quality healthcare is a right, not a privilege when dealing with budget concerns.

"Medical care costs money, so (officials should) come up with cost-saving techniques. But if cost saving leads to negligible care, that's a big concern," Gotsch said.


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