The Institutional Effects of Incarceration: Spillovers From Criminal Justice to Health Care.
CONCLUSIONS
The steady increase in incarceration is related to the quality and functioning of the health care system. US states that incarcerate a larger number of people show declines in overall access to and quality of care, rooted in high levels of uninsurance and relatively poor health of former inmates. Providing health care to former inmates would ease the difficulties of inmates and their families. It might also prevent broader adverse spillovers to the health care system. The health care system and the criminal justice system are related in real but underappreciated ways.


BACKGROUND
This study examines the spillover effects of growth in state-level incarceration rates on the functioning and quality of the US health care system.


METHODS
Our multilevel approach first explored cross-sectional individual-level data on health care behavior merged to aggregate state-level data regarding incarceration. We then conducted an entirely aggregate-level analysis to address between-state heterogeneity and trends over time in health care access and utilization.


RESULTS
We found that individuals residing in states with a larger number of former prison inmates have diminished access to care, less access to specialists, less trust in physicians, and less satisfaction with the care they receive. These spillover effects are deep in that they affect even those least likely to be personally affected by incarceration, including the insured, those over 50, women, non-Hispanic whites, and those with incomes far exceeding the federal poverty threshold. These patterns likely reflect the burden of uncompensated care among former inmates, who have both a greater than average need for care and higher than average levels of uninsurance. State-level analyses solidify these claims. Increases in the number of former inmates are associated simultaneously with increases in the percentage of uninsured within a state and increases in emergency room use per capita, both net of controls for between-state heterogeneity.


CONCLUSIONS
Our analyses establish an intersection between systems of care and corrections, linked by inadequate financial and administrative mechanisms for delivering services to former inmates.
University of Pennsylvania.
Jason
J
Schnittker
University of Minnesota.
Christopher
C
Uggen
University of Georgia.
Sarah K S
SK
Shannon
University of Minnesota.
Suzy Maves
SM
McElrath
D006297:Health Services Accessibility; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data; D008297:Male; D017057:Medically Uninsured; D011329:Prisoners / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data; D011787:Quality of Health Care; D014481:United States
health care; incarceration; spillover