While the bulk of cost containment efforts focus on negotiating lower prices for pharmaceuticals; hiring staff physicians; reviewing cost bills; reducing prices for purchased hospital services, etc. Other sections focus on reducing utilization of health care services by charging access fees to prisoners (AKA "co-payments"). The book discusses various court rulings dealing with medical access fees. As a practical matter the book dryly notes that: "The risk of an across the board co-payment requirement is that prisoners may be dissuaded from seeking necessary treatment or from seeking treatment early enough to avert higher cost treatments later. If co-payment policies do indeed result in more expensive treatment because earlier attention was not sought, they may be cost ineffective."
The book analyzes the co-payment system in Nevada noting the collection rate of the $4 fee was 52%. While the amount of money collected from such co-payments averaged $11,088 a year between 1983 and 1993, this represented .3% of the Nevada DOC's medical budget. Nevada prison officials credited the fee with reducing medical utilization by prisoners by 50% DOC wide. One Nevada DOC administrator was quoted saying the amount collected is misleading because "given the small volume of revenue collected, an inordinate amount of staff time is involved in collecting the co-payment charges."
An interesting side note, Chase Riveland, former boss of the Washington DOC is a member of the advisory board that wrote this book. Despite the book's findings on medical co-payments in 1995 Riveland had legislation introduced to charge prisoners a $3 medical fee each time they sought medical attention.
Anyone interested in prison health care will find the book interesting and informative. The book is available at no cost from: U.S. Dept. of Justice, Office of Justice Programs, National Institute of Justice, Washington D.C. 20531.
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