Nationwide, spending on health care and on corrections is putting serious pressure on state budgets. Medicaid—the largest component of states' health care spending—has been the fastest-growing part of state expenditures over the past two decades, with corrections a close second.
Inmates' health, the public's safety, and taxpayers' total corrections bills are all affected by how states manage prison health care services. Effective treatment of inmates' physical and mental ailments, including substance abuse, improves the well-being of prisoners and can reduce the likelihood that they will commit new crimes or violate probation once released.
To better understand spending for inmate health services, researchers from The Pew Charitable Trusts analyzed cost data from the 44 states that were examined in a study by the federal Bureau of Justice Statistics, or BJS.
Prisoners have a constitutional right to adequate medical attention, and states are legally required to ensure that cost-containment strategies preserve health care quality for incarcerated offenders.
Pew found that prison health care spending in these 44 states totaled $6.5 billion in 2008, out of $36.8 billion in overall institutional correctional expenditures. Most states' correctional health care spending increased substantially from fiscal 2001 to 2008, the years included in the BJS report:
This significant growth reflects, in part, the rise in prison populations nationally. Higher per-inmate expenses and the expanding slice of corrections budgets devoted to health care suggest that other factors are also pushing costs up, including:
Pew researchers interviewed correctional health care experts across the country to identify innovative strategies to deliver health care to inmates, protect public safety, and control costs.
The report highlights four approaches that were cited frequently during the expert interviews and have produced positive outcomes in some states:
These examples offer important lessons as policymakers seek the best ways to make their correctional health care systems effective and affordable.
These examples offer important lessons as policymakers seek the best ways to make their correctional health care systems effective and affordable.
This chart was updated in May 2014 to reflect revised North Carolina and Oregon spending data published by the Bureau of Justice Statistics after our report’s initial release.
This chart was updated in May 2014 to reflect revised North Carolina and Oregon spending data published by the Bureau of Justice Statistics after our report’s initial release.