The prison population in this country is made up of people that become largely invisible as soon as they step foot into the correctional justice system. This is because formerly incarcerated citizens become ineligible for many jobs, and 6.1 million Americans are not allowed to vote due to a felony conviction. Moreover, the United States has the unfortunate distinction of having the highest incarceration rate in the world. According to Prison Policy Initiative, the numbers are daunting:
The American criminal justice system holds more than 2.3 million people in 1,719 state prisons, 102 federal prisons, 901 juvenile correctional facilities, 3,163 local jails, and 76 Indian Country jails as well as in military prisons, immigration detention facilities, civil commitment centers, and prisons in the U.S. territories.
PPI explains that part of the reason the numbers are so high is that most people in jails have not yet been convicted. How do these numbers affect the quality of healthcare administered to those who are currently incarcerated? And how can healthcare policy administrators help ensure that former inmates continue to receive health care after their release from prison? I recently came across the disturbing finding that African-American men receive better health care while incarcerated than those outside the prison system. BET was quick to offer the caveat that prison shouldn’t be viewed as being more beneficial for black men’s lives. Rather, the healthcare system in the U.S. needs a major overhaul—especially when it comes to being adequately accessible to minority populations.
Since most conservative states chose to reject the optional expansion of Medicaid coverage offered under the Affordable Care Act, the nature of available health care after release is likely dependent upon one’s state of residence. According to Pew Trusts, “States that expand their Medicaid eligibility under the ACA will generally realize the largest savings from this option because most inmates, as nondisabled adults without dependent children, are eligible for Medicaid coverage only under the expansion.” Therefore, public administrators working in the healthcare field may have more work available to them in states that accepted the expansion, since they are tasked with making sure organizations follow federal regulations.
Public administrators also likely have their proverbial hands full when it comes to addressing the underlying causes of poor health in prison inmates, specifically, considering the extent to which prisons are overcrowded in the U.S. The alteration of the “three strikes” law that assigned life sentences to those convicted to three felonies will help nonviolent offenders be released from prison sooner than before, but there is still an overcrowding problem. The effects of this overcrowding on prison health is easy to imagine; they include the prevalence of infectious diseases and psychiatric disorders, as well as an insufficient water supply in places like California.
The overcrowding leads to stress, which can lead to anxiety, depression and violence. For this reason, mental health resources are likely even more crucial within prisons than in other settings. Although GPS and family mapping technology has been widely utilized to help manage caseloads for correctional officers, public health administrators working with inmates should consider the use of healthcare technology like telemedicine and heart monitors for use with prison populations. Many mobile health trackers and apps can detect warning signs related to heart attacks and strokes, for example. Telemedicine has been utilized successfully with patients from New York City’s Rikers Island jail complex, where Dr. Vinh Pham treats patients remotely, eliminating the need for inmates to be transported.
Considering the fact that many prison facilities are located in rural areas, telemedicine helps patients access high quality care—especially for more complex acute and chronic conditions like rheumatoid arthritis or diabetes. One barrier that still exists, however, is the amount of available funding for telemedicine—which isn’t necessarily covered under Medicaid or don’t apply to incarcerated individuals. In states with less federal funding for prison healthcare, or more private prisons (which don’t mandate internal health care), the situation is even worse. Arizona, for example, relies on private contractors for health care services—with disastrous results.
Add to that the extent to which, according to Arshya Vahabzadeh, our correctional system has become our mental health system, and we have the makings of a system that is in dire need of psychiatric help. Telehealth could help with this shortcoming immensely. Vahabzadeh also makes an important point about another way that the prison population is invisible: most of the rapidly rising number of wellness and mental health startups making apps or other products in Silicon Valley focus on developing products for the general population—ignoring the needs of niche groups such as incarcerated populations.
Due to the high probability of corruption in the current system, however, it’s crucial that medical care be federally regulated—hence subject to guidelines and standards. However, it’s not that simple, since more healthcare services are being outsourced to private medical companies, which are more cost-cutting, on first glance, but tend to provide minimal and generally less extensive care than federally-provided in-house clinics. Therefore, they end up costing correctional facilities and the federal government more money, due to the necessity of repeat care.
Those interested in following the issue may want to keep track of legislation related to telemedicine in the House and Senate. For example, the ECHO Act aims to expand telemedicine to more rural areas by providing specialized training for medical professionals interested in using the technology to reach more patients. However, there are existing coverage restrictions that need to be lifted in order for healthcare providers to be able to be reimbursed for their services, so we need to expand funding for Medicare and Medicaid—rather than the reverse (what the Republican majority in the House and Senate wants to do).
Without the political and large-scale will to change the way healthcare is funded, telemedicine may never truly get off the ground. There is clearly an interest from the medical community, as well as current inmates. One possible source of funding, at the moment, comes from grants—check out the Rural Health Information Hub for more details.
* * *
Prisons clearly need more funding and fewer inmates in order to help alleviate the burden on their healthcare systems. Telemedicine seems poised to make a significant difference—assuming that it can secure the necessary funding and resources needed to extend the available medical help to incarcerated individuals with few other options. It would be more cost effective, more time-efficient, and potentially easier and less intimidating for those who need care.
Share your thoughts on how technology can help improve health care in the prison system in the comments section, below.
* * *
Image Source: Bart Everson