Paying the price: The national lack of publically available prison healthcare cost data

Background: The U.S. prison population is aging rapidly. Over 10% of prisoners are age 50 or older and older prisoners often have poor health and adverse health outcomes leading to high medical costs. Prior research using the Dartmouth Atlas of Health Care has shown that easily accessible, publically available data can serve as a powerful tool to compare outcomes across health care systems and identify the drivers of healthcare costs. Objectives: As the rising cost of incarceration is associated primarily with prison healthcare and aging prisoners, we sought to determine whether a national data compendium of correctional healthcare cost by age and expenditure category could be assembled. Methods: We reviewed all current publically available statistics, annual reports and special reports from the Departments of Corrections of all 50 states. Through content analysis, we identified opportunities to improve the availability of relevant data. Results: All 50 Departments of Correction issue publically available annual statistical reports and 90% make available some prison healthcare cost information. Yet none provide a systematic breakdown of prisoner healthcare costs by age and only 5 states (10%) report healthcare costs by expenditure categories such as personnel, prescription medication, or outside medical care. Four states (8%), however, issued special reports in the last decade that estimated an average ratio of healthcare costs for “older” versus “younger” prisoners of 3.8:1. Finally, 23 (46%) did not clearly define the age of “older prisoners” while others vary significantly in the age cutoff used, ranging from 40 to 65 years old. Discussion: Despite the rapid aging of U.S. prisoners and the associated rise in prison healthcare costs, no state reports annual data on prison healthcare costs by age and expenditure category. This absence of data represents a significant missed opportunity to engage in serious, cost-reducing correctional health policy reform as would be made possible by a data source like the Dartmouth Atlas. To provide researchers, public officials, and policy-makers with a vital tool to address the budgetary and healthcare crises in American corrections, we recommend four simple changes to data collection and dissemination by state Departments of Corrections: (1) determine a uniform age for “older prisoners” with input from experts in health and aging in the criminal justice system; (2) adjust data collection tools to report age-stratified health expenditures; (3) expand data to include health expenditures by category; and (4) disseminate data in the annual reports currently issued by all 50 states.