Unintended Consequences of Sentencing Policy: The Creation of Long-Term Healthcare Obligations

The Federal Bureau of Prisons provided data about health care utilization by prisoners. Using those data, statistical models of how costs increased for male offenders based on their age when entering prison and time spent in prison were developed. The estimates are specific to 200 types of medical conditions that occur most frequently among Federal inmates. Models of medical conditions suffered by inmates were divided into three types: intermittent, chronic with intermittent recurrence, and chronic requiring continuous treatment. This study provides an approach to the problem of projecting prisoners’ health care needs and contains preliminary estimates for figuring how health care costs will increase as the VOTIS alters the number and mix of prison inmates. Two empirical tests were proposed to distinguish between medical conditions that were chronic and those that were not chronic. It was determined that empirical tests alone could not determine how to classify medical conditions. Offenders will go without medical care, so that when they enter prison, the need for medical care is immediate. Findings also suggest that predictions of the need for medical care cannot be based upon the prevalence of disease outside of prison. It was reasonable to assume that prisoners suffer from certain medical conditions at higher rates than do others who are not involved with the criminal justice system. Those who go through prisons and jails account for a large proportion of diseases such as HIV, AIDS, TB and Hepatitis B and C. Findings also suggest that prison can retard the onset of certain medical conditions. Medical care received in prison can be preventative and/or early diagnoses can lead to more effective treatments. Furthermore, inmates are removed from unhealthy conditions and introduced to healthy conditions in prison. In summary, there is conceptual problem converting medical treatment into costs due to prisons varying greatly in the quality and quantity of treatment given to inmates. There is no universal standard. With inmates entering prison with preexisting medical conditions, it becomes difficult to answer the initial research question of how medical health care costs change as prisoners age. Some medical conditions actually decrease with age. In making projections of health care needs requires some adequate way of modeling the healthy or unhealthy effects that prisons have on the incidence and prevalence of medical conditions. Tables, figures, appendices, and research note