The Future of Prison Health Care: Trends and Challenges
Rising Health Care Costs in North Carolina Prisons
The Department of Adult Correction in North Carolina faces a daunting challenge: providing constitutionally mandated health care to over 31,000 incarcerated individuals. According to a fiscal analyst’s presentation to state lawmakers, health care costs have skyrocketed, reaching $429.1 million in the fiscal year 2023-24. This figure represents a staggering 36 percent increase over the past five years and accounts for about one-quarter of the department’s annual budget.
Factors Driving the Cost Increase
Several factors contribute to this escalating cost:
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Aging Population: The incarcerated population is aging rapidly. Over the past decade, the number of individuals over 60 has doubled, now comprising 10 percent of the prison population. This demographic shift increases health care needs and costs.
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High Medical Needs: Incarcerated individuals often have chronic health issues, including diabetes, high blood pressure, HIV, and mental health problems. These conditions require ongoing medical attention and treatment.
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Constitutional Obligations: The department is legally obligated to provide health care, which includes medical, mental, and dental services. This obligation adds to the financial burden.
- Industry Costs: General increases in health care industry costs also impact the prison system.
Budget Overruns and Funding Gaps
Health care expenditures have consistently exceeded budgeted amounts for at least a decade. In the fiscal year 2023-24, the department faced a $48.1 million overage. Despite additional funding allocations, such as the $50 million for medical budget deficiencies and $3.4 million for pharmacy operating costs in the 2021 state budget, these funds were insufficient to close the gap. The department has had to rely on lapsed salaries to cover these overages.
The Scope of Health Care Services
The Department of Adult Correction’s Comprehensive Health Services Division recorded 1.4 million health encounters in 2024. These encounters included:
- Nurses: Just under 700,000 visits
- Medical Providers: 418,000 visits
- Psychological and Social Workers: 170,000 visits
- Dental Staff: 88,600 visits
- Psychiatrists: 40,000 visits
Most of this care is provided within the prisons, with routine outpatient care available at all facilities and inpatient care at Central Prison and the North Carolina Correctional Institution for Women in Raleigh. Specialized care, such as surgeries, is provided at community medical clinics and hospitals.
Financial Barriers to Care
While health care is provided, incarcerated individuals are charged copays for medical and dental services. In 2023, the prison system collected $353,673 in copay fees. These fees can pose a barrier to care, as low prison wages make it difficult for individuals to afford necessary medical services.
Addressing the Sicker Population
People in prison are generally sicker than the general population. This includes a higher prevalence of chronic health problems, mental health issues, and substance use disorders. The aging population and the adverse effects of incarceration on health further exacerbate these challenges.
Mental Health and Substance Use Treatment
- Mental Health: About one-quarter of the incarcerated population is on the mental health caseload. The department spent $45 million on mental health care last fiscal year, with most services provided through telehealth.
- Substance Use Disorders: Nearly 80 percent of individuals entering prison have a substance use disorder. The department’s Alcoholism and Chemical Dependency Programs cost $16 million last fiscal year, but demand for treatment significantly outpaces availability.
Rising Pharmacy Costs
Pharmacy-related expenses account for nearly 20 percent of the department’s health expenditures, totaling $76 million. The aging population and the need for hepatitis C treatment are significant drivers of these costs. Hepatitis C treatment, which is highly effective but expensive, has seen a dramatic increase in spending, from $4.6 million in 2019 to $25.4 million in 2024.
Staffing Challenges and Solutions
Persistent staff vacancies make providing health care more challenging. The Department of Adult Correction has a 24 percent overall vacancy rate, with health care positions at 28 percent and nurse positions at 37 percent. To address these challenges, the department has turned to contract or travel nurses, who are more expensive on a per capita basis.
Overtime and Staff Retention
The department has relied heavily on overtime to keep operations running. In the fiscal year 2023-24, $67.7 million was spent on overtime, over 11 times the budgeted amount. Low pay and excessive overtime are significant reasons for staff turnover. The starting salary for a new correctional officer is just over $37,600, which is significantly lower than in neighboring states.
Future Trends and Solutions
Aging Population and Health Care Needs
The aging prison population will continue to drive up health care costs. As individuals age, their health care needs and costs increase. This trend is expected to continue, necessitating more resources and innovative solutions.
Technological Innovations
Telehealth services have become a crucial component of mental health care in prisons. This trend is likely to continue, with more virtual clinics and remote consultations becoming the norm.
Policy and Funding
Increased funding and policy changes will be necessary to address the growing health care needs of the incarcerated population. This includes allocating more resources for mental health and substance use treatment, as well as improving staff retention through better pay and benefits.
Did You Know?
North Carolina’s incarcerated population is aging rapidly. Over the past decade, the number of individuals over 60 has doubled, now comprising 10 percent of the prison population. This demographic shift increases health care needs and costs.
FAQ Section
Q: Why are health care costs in North Carolina prisons increasing?
A: Health care costs are increasing due to an aging population, high medical needs, constitutional obligations, and general industry cost increases.
Q: How does the Department of Adult Correction cover budget overruns?
A: The department has relied on lapsed salaries to cover budget overruns, but this is not a sustainable long-term solution.
Q: What are the main health challenges faced by the incarcerated population?
A: The incarcerated population has a higher prevalence of chronic health problems, mental health issues, and substance use disorders.
Q: How does the department address staffing challenges?
A: The department has turned to contract or travel nurses and relies heavily on overtime to keep operations running.
Q: What are the future trends in prison health care?
A: Future trends include an aging population, increased use of telehealth, and the need for more funding and policy changes to address growing health care needs.
Pro Tips for Better Health Care in Prisons
- Invest in Preventive Care: Focus on preventive care to reduce long-term health care costs.
- Improve Staff Retention: Offer better pay and benefits to attract and retain qualified health care professionals.
- Leverage Technology: Expand telehealth services to provide more accessible and efficient care.
- Increase Funding: Advocate for increased funding to meet the growing health care needs of the incarcerated population.
Call to Action
Share your thoughts on the future of prison health care in the comments below. Have you experienced or witnessed the challenges of providing health care in prisons? What solutions do you propose? Explore more articles on health care trends and challenges, and subscribe to our newsletter for the latest updates.