Co-pays block inmates from accessing health care: study
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Inmates in U.S. prisons appear to not be seeking the health care they need because they can't afford co-pays, per a study in JAMA Internal Medicine.
Why it matters: Co-pays, found in up to 90% of state and federal prisons, could be a barrier to addressing the increasing prevalence of chronic health conditions among the incarcerated.
What they found: The study, led by the Cambridge Health Alliance and Harvard researchers, looked at a nationally representative sample of people in U.S. state and federal prisons in both 2016 and 2004 from the Bureau of Justice Statistics' Survey of Prison Inmates.
- Roughly 10% of those with at least one chronic condition in 2016 and who had been incarcerated longer than one year had not seen a health care clinician during their incarceration.
- Among respondents with at least one chronic mental health condition who had been incarcerated a year or longer, 29.3% had never received mental health treatment during their incarceration.
- Among respondents who were pregnant while incarcerated, 9.1% received no obstetrical exam between incarceration and delivery.
By the numbers: Prison wages typically range between 4 cents and 40 cents an hour, making a $2 to $8 co-pay equate to a roughly $69 to $1,090 co-pay for the same number of hours of work among people who aren't incarcerated, the authors write.
- Of state prison residents, 90% were in facilities requiring co-payments, including 63% in facilities with co-payments exceeding one week's prison wage.
- About 54% of incarcerated pregnant people and 62% of people with at least one chronic health condition had a co-payment greater than one week's prison wage.
Between the lines: The authors acknowledge the limits of the study, saying the 2016 data was the most recent available and included self-reported data that could be subject to recall bias. It was also not possible to tease out which individuals might have had co-pay waivers.
- "The findings of this cross-sectional study underscore the urgency of interventions to improve prison health care," the authors wrote.
