Jails: Inadvertent Health Care Providers – 2018

Every year, millions of people are booked into U.S. jails. During 2015, the latest year for which data are available, there were 10.9 million admissions to these correctional facilities, which hold individuals who are awaiting trial or serving short sentences. The government running the jail—usually a county—has a constitutional mandate to provide people booked into these facilities with necessary health care. Counties designing a jail health care program targeted to meet the needs of their incarcerated population have the opportunity to improve the health of people in jail and the broader community, spend public dollars more effectively, and, in some cases, reduce recidivism.

Yet little is known about how jails administer their health care programs and whether these programs further county public health and safety goals. Research is limited on how counties organize their jail health care services, what care they make available and when, and how they ensure they receive value for their investment in health care. Despite growing awareness of the connection between community services for recently released individuals—especially those with mental illness or substance use disorders, collectively known as behavioral health disorders—and a reduction in recidivism, information about how to achieve this result is scarce.

In an effort to give counties tools to improve delivery of services to an underserved population with high needs, The Pew Charitable Trusts, with the assistance of Community Oriented Correctional Health Services, reviewed 81 requests for proposals (RFPs) for contracted jail health care services and conducted in-depth case studies of three jurisdictions. (See the methodology for more detail.) This research revealed wide variation in the ways that counties arrange to provide health care in their jails and the information they supply to help vendors craft bids. Additionally, despite growing recognition of the health needs of those currently and formerly in jail, our analysis found varying approaches to whether and how jails prepare individuals to manage their health once released.

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The Pew Charitable Trusts
January 24, 2018