Potential finance lessons from prison healthcare


America's aging population is driving much debate about how healthcare dollars should be devoted over the next few decades, but it often ignores a sizable portion of that equation: inmates. How they're cared for could prove an opportunity for the healthcare sector.

The United States imprisons about 2.5 million people, five times the rate of a few decades ago. Just because inmates are doing time doesn't mean that it's passing them by: That population is aging just as their non-incarcerated counterparts.

However, we're conflicted about healthcare for the convicted, with my home state of California perfectly illustrating this tug-of-war. Its prison system has been in special receivership for the past half-dozen years because inmates were dying weekly due to care being denied. It was a state of affairs that the federal courts declared unconstitutional.

After all these years of federal oversight, more doctors have been hired to practice in the prison system. Work has commenced on a 1,275-bed hospital in Stockton, Calif., devoted specifically to treat inmates. It's about a third larger than the biggest acute care facility in the state, and given the cost of building a bed here, is probably going to cost north of $2 billion.

Last summer, a state senator introduced a bill that would compel California to not spend any more than the provider rates for the state Medicaid program, among the lowest in the nation.

"Prisoners should never get better healthcare than brave veterans that defend our freedoms or hardworking people that fall on tough times," said Sen. Michael J. Rubio, a Democrat, last June. The bill became law last fall, but was refocused on the transparency of prison contracts and with the spending provision stripped out.

The intent of lawmakers such as Rubio tends to ignore that the prison population here and nationwide is beset with chronic conditions,  including HIV and hepatitis. Many also grew up poor, meaning they never got appropriate preventive treatments. As a result, their care will likely be much more than someone who's never run afoul of the law. The United States has an ongoing issue of equating dollars spent with the quality of care delivered.

There are alternatives to treating all these aging prisoners, such as releasing them early and letting them enter Medicaid or Medicare. But cutting sentences is politically unfeasible these days. What's likely to happen is the nation's corrections system is going to have to care for their charges with fewer healthcare resources than devoted to those on the outside.

This austere environment could prove a testing ground for developing pathways of cheaper quality care for non-inmates. Of course, the punitive environment of the corrections system may compromise such methods. There are a lot of prison healthcare personnel who could care less about outcomes.

Then again, my 10-year-old daughter rarely leaves the house without her laceless sneakers, and it's awfully hard to walk a block in a major urban area without seeing people sporting tattoos and baggy jeans--all fashion trends born in the prison system. If a decade down the line some of its other practices migrate into healthcare, it's entirely possible it might be a sign of progress rather than alarm. - Ron (@FierceHealth)

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