Health Care Needs of Returning Prisoners and Challenges Safety Net Providers Face in Meeting Those Needs

This paper examines public health implications of prisoner reentry in California from a provider's perspective, including the re-entry population's specific healthcare needs, communities disproportionately affected, and healthcare system responses. Using survey data from the Bureau of Justice Statistics, we first characterized the health care needs of returning prisoners in California, finding that they are disproportionately sicker on average than the general population. Using GIS and administrative data from the state corrections department and state and county health departments, we also identified which counties have the highest concentration of parolees and assessed the accessibility and capacity of safety-net providers to serve this population. We find that there are serious gaps in some areas, where there are large concentrations of parolees, but relatively few providers to meet their needs. To understand the challenges providers and community organizations face in meeting the health care needs of parolees, we conducted semi-structured interviews in three counties with the highest concentration of parolees (Los Angeles, San Diego, and Alameda) with primary care, mental health, and drug treatment providers. We examine the challenges providers face including low levels of health insurance and lack of eligibility for many publicly-funded insurance programs, difficulties navigating the safety-net due to lack of information and low literacy, and problems in communication between the reentry population and safety-net providers. We discuss the implications of our findings including improving care for the reentry population, where improvements are most needed (types of services, geographic areas), and strategies to improve access to health care services.