Raimer Ben G, Stobo John D
Office of Community Outreach, University of Texas Medical Branch, Galveston 77555-0129, USA.
JAMA. 2004 Jul 28;292(4):485-9. doi: 10.1001/jama.292.4.485.
Faced with explosive growth in its prison population and a legal mandate to improve medical care for incarcerated offenders, the state of Texas implemented a novel correctional managed health care program in 1994. The organizational structure of the program is based on a series of contractual relationships between the state prison system, 2 of the state's academic medical centers, and a separate governing body composed of 9 appointed members, which include 5 physicians. All medical, dental, and psychiatric care for more than 145,000 offenders, incarcerated under the jurisdiction of the Texas Department of Criminal Justice, is provided by the University of Texas Medical Branch and Texas Tech University Health Sciences Center. The health delivery system is composed of several levels of care, including primary ambulatory care clinics in each prison unit, 16 infirmaries at strategic locations throughout the state, several regional medical facilities, and a dedicated prison hospital with a full range of services. Specialized treatment programs have been established at various units for patients with chronic conditions, such as hypertension, diabetes mellitus, major psychiatric disorders, hepatitis, and human immunodeficiency virus infection. Significant improvements in health outcomes have occurred since the managed care program was established.
面对监狱人口的爆炸式增长以及改善对被监禁罪犯医疗护理的法律要求，德克萨斯州于1994年实施了一项新型的惩教管理医疗保健计划。该计划的组织结构基于州监狱系统、该州的两所学术医疗中心以及一个由9名指定成员组成的独立管理机构之间的一系列合同关系，其中包括5名医生。德克萨斯刑事司法部管辖下被监禁的超过14.5万名罪犯的所有医疗、牙科和精神护理，均由德克萨斯大学医学分部和德州理工大学健康科学中心提供。医疗服务系统由几个护理级别组成，包括每个监狱单位的初级门诊护理诊所、全州战略位置的16个医务室、几个区域医疗设施以及一家提供全方位服务的专门监狱医院。各单位已为患有慢性病（如高血压、糖尿病、重度精神障碍、肝炎和人类免疫缺陷病毒感染）的患者设立了专门治疗项目。自管理式医疗保健计划设立以来，健康结果有了显著改善。
