Cross-National Correctional Health Care
| Author | Russell Porter, Nathan Moran, Roe Roberts, Beverly Stiles |
| Pages | 87-91 |
Page 87
Several health-care structural frameworks exist, including: (1) a government-oversight model in which government interaction with the facility is assessed; (2) a rational-contingency model based on customer needs; and (3) a resource-dependency model in which resources are consumed according to availability.
Ezekiel Emanuel (1991) describes four "schemes" in which health care is provided within a government-oversight framework. As a continuum, this framework starts with the high-technology, ability-to-pay model of health care that is most identified with the United States. In such a system, not all individuals have health insurance, but they do have access to medical technology if they visit an emergency room. For those who are incarcerated, this type of health-care framework is analogous to all types of health care being provided either onsite or in an emergency room.
With a growing population of aging detainees, there is a significant need to deal with the chronic medical conditions that such detainees face. Emanuel describes the National Health Care System in Britain, in which all detainees have access to health care, but at the lowest possible cost. This system permits detainees access to such medical technology as x-rays or ultrasound, but not high-cost CAT or MRI scans.
In the rational-contingency model, a structure is created based on the differing needs of a variety of customers. For example, as the degree of customer homogeneity increases, there is less need for programs that address a diversity of health-care situations. In a heterogeneous customer environment, in contrast, there is a need for wide variations of programs. For correctional facilities that house different types and genders of offenders, the need for more complex health-care programs is greater than in facilities that house only male or female detainees or only those who have committed minor infractions.
With the resource-dependency model, it does not matter what type of government oversight exists or what type of needs are represented by those who are incarcerated, since this type of health-care system depends primarily on the availability of funding allocated for the care of detainees. The resource-dependency model "emphasizes the importance of the organization's abilities to secure needed resources from its environment in order to survive" (Shortell and Kaluzny 1997, p. 23). Although it is considered important to provide health care to detainees, it may be impossible when there are limited funds available for health care in correctional facilities. More importantly, the resource-dependency model emphasizes that the systems that succeed are those that plan and interact the most effectively with their sources of funding (Ouchi 1981; Pfeffer and Salancik 1978).
In the United States, a significant source of information on correctional health care is the National Commission on Correctional Health Care (NCCHC). The NCCHC accredits correctional health-care facilities, including clinics and stand-alone acute-care facilities. According to the NCCHC and other sources, the most pressing issues in correctional health care in the United States are HIV/AIDS, hepatitis, and tuberculosis.
Page 88
In terms of structure, the U.S. correctional system employs the full range of health-care frameworks—government-oversight, government-managed, and various private arrangements, especially for those incarcerated for long periods. There are also many sources of funding in the United States for correctional health care; all levels of government (local, state, and national), as well as private funds, provide resources for correctional facilities. Compared to other countries, the U.S. prison system has the greatest variety of structures and resource sources. There are, however, many similarities in the ways U.S. institutions are attempting to meet the needs of incarcerated HIV/AIDS, hepatitis, and tuberculosis patients. The high rate of such chronic diseases among prisoners has a major impact on health-care costs in correctional facilities.
Like the United States, Canada employs a variety of models of government oversight and resource procurement for prison health care. However, there are only a small number of privately run facilities in Canada, and those exist only at the provincial level. Also like the United States, Canada has a problem with the type of outcomes relating to those who are incarcerated. A high percentage of the Canadian prison population is infected with HIV/AIDS and hepatitis C, and those rates are expected to increase.
In South America, Chile and Peru showed a growing trend toward privatizing the oversight of correctional health care. Information on Brazilian correctional health care is more readily available than for Chile and Peru. Brazilian correctional health-care systems are predominately government-run, although there is an increasing move toward privatization. As in many other countries, the prevalence in Brazil of incarcerated individuals with HIV is high (Tourinto and Dourado 2002). The number of prisoners in Brazil with hepatitis C was also high, and the infection rate has been found to increase due to incarceration (Brandao and Costa Fuchs 2002).
The following countries in Europe and the Middle East were assessed: Israel, Switzerland, Romania, France, Italy, Spain, and Germany.
The Israeli Prison Service houses more than ten thousand inmates; about 20 percent are incarcerated for offenses against the state. According to Physicians for Human Rights, an American-based...
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