Our panel of nurse experts drills deep into the recently published Pew Report on Prison Healthcare Spending to discuss implications and compare their experiences with the report’s recommendations. Panelists include Johnnie Lambert, correctional nurse and Vice-President, Clinical Operations, Policy and Accreditation with Armor Correctional Health Services, Inc. ; Mari Knight, Mid-Atlantic Transition, Training and HSA Support Nurse for Conmed Healthcare Management; and Catherine Knox, correctional nurse consultant from Portland Oregon.

The Pew Report on Prison Healthcare Spending is an extensive document chronicling the rising expense of providing healthcare to our inmate patients. It identifies trends we are all too aware of with familiar causes such as aging patients with high prevalence of infectious and chronic diseases, as well as mental illness and substance abuse. The report also describes challenges we have with location, transportation, and staffing – which we don’t often see in print. Since the mid 1970’s when inmate healthcare was established as a constitutional right, correctional healthcare costs have risen almost 700%. The first part of the report lays the groundwork for why correctional healthcare costs are escalating. The later half of the report documents various state responses to increasing prison healthcare costs. Examples provided include telehealth, outsourcing care, Medicaid financing, and medical or geriatric parole. Panelists provide thoughts on the uses of telehealth described in the report and whether we have fully exploited this technology in corrections. Outsourcing is also explored and panelists agree that this is a promising cost containment strategy. The third theme of the report is Medicaid financing. In some ways this seems like cost shifting (from state to federal tax dollars) rather than cost savings, but there are ways to make it work. The final theme offered in the Pew report is the use of medical or geriatric parole. The report suggests that recidivism is low among elderly inmates but acknowledges this is a political hot potato. Correctional systems need to carefully implement this strategy to make it work.