Paying the Price: The Pressing Need for Quality, Cost, and Outcomes Data to Improve Correctional Health Care for Older Prisoners

Authors

  • Cyrus Ahalt MPP,

    1. Division of Geriatrics, Department of Medicine, University of California at San Francisco, San Francisco, California
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  • Robert L. Trestman PhD, MD,

    1. University of Connecticut Health Center, Farmington, Connecticut
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  • Josiah D. Rich MD, MPH,

    1. Brown Medical School, Providence, Rhode Island
    2. Center for Prisoner Health and Human Rights, Brown University, Providence, Rhode Island
    3. Miriam Hospital, Providence, Rhode Island
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  • Robert B. Greifinger MD,

    1. John Jay College of Criminal Justice, City University of New York, New York, New York
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  • Brie A. Williams MD, MS

    Corresponding author
    1. Division of Geriatrics, Department of Medicine, University of California at San Francisco, San Francisco, California
    2. San Francisco Veterans Affairs Medical Center, San Francisco, California
    • Address correspondence to: Brie A. Williams, Division of Geriatrics, University of California, San Francisco, 3333California Street, Laurel Heights, Suite 380, San Francisco, CA 94118. E-mail: brie.williams@ucsf.edu

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  • [Editorial comments by Terry E. Hill, pp. 2040–2042]

Abstract

Despite a recent decline in the U.S. prison population, the older prisoner population is growing rapidly. U.S. prisons are constitutionally required to provide health care to prisoners. As the population ages, healthcare costs rise, states are forced to cut spending, and many correctional agencies struggle to meet this legal standard of care. Failure to meet the healthcare needs of older prisoners, who now account for nearly 10% of the prison population, can cause avoidable suffering in a medically vulnerable population and violation of the constitutional mandate for timely access to an appropriate level of care while incarcerated. Older prisoners who cannot access adequate health care in prison also affect community healthcare systems because more than 95% of prisoners are eventually released, many to urban communities where healthcare disparities are common and acute healthcare resources are overused. A lack of uniform quality and cost data has significantly hampered innovations in policy and practice to improve value in correctional health care (achieving desired health outcomes at sustainable costs). With their unique knowledge of complex chronic disease management, experts in geriatrics are positioned to help address the aging crisis in correctional health care. This article delineates the basic health, cost, and outcomes data that geriatricians and gerontologists need to respond to this crisis, identifies gaps in the available data, and anticipates barriers to data collection that, if addressed, could enable clinicians and policy-makers to evaluate and improve the value of geriatric prison health care.

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