Harvey Tyler D, Busch Susan H, Lin Hsiu-Ju, Aminawung Jenerius A, Puglisi Lisa, Shavit Shira, Wang Emily A
SEICHE Center for Health and Justice, Yale School of Medicine, 300 George Street, Suite G05, New Haven, CT, 06511, USA.
Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA.
BMC Health Serv Res. 2022 Apr 30;22(1):585. doi: 10.1186/s12913-022-07985-5.
Criminal justice system costs in the United States have exponentially increased over the last decades, and providing health care to individuals released from incarceration is costly. To better understand how to manage costs to state budgets for those who have been incarcerated, we aimed to assess state-level costs of an enhanced primary care program, Transitions Clinic Network (TCN), for chronically-ill and older individuals recently released from prison.
We linked administrative data from Connecticut Department of Correction, Medicaid, and Department of Mental Health and Addiction Services to identify a propensity matched comparison group and estimate costs of a primary care program serving chronically-ill and older individuals released from incarceration between 2013 and 2016. We matched 94 people released from incarceration who received care at a TCN program to 94 people released from incarceration who did not receive care at TCN program on numerous characteristics. People eligible for TCN program participation were released from incarceration within the prior 6 months and had a chronic health condition or were over the age of 50. We estimated 1) costs associated with the TCN program and 2) costs accrued by Medicaid and the criminal justice system. We evaluated associations between program participation and Medicaid and criminal justice system costs over a 12-month period using bivariate analyses with nonparametric bootstrapping method.
The 12-month TCN program operating cost was estimated at $54,394 ($146 per participant per month). Average monthly Medicaid costs per participant were not statistically different between the TCN ($1737 ± $3449) and comparison ($1356 ± $2530) groups. Average monthly criminal justice system costs per participant were significantly lower among TCN group ($733 ± $1130) compared with the matched group ($1276 ± $1738, p < 0.05). We estimate every dollar invested in the TCN program yielded a 12-month return of $2.55 to the state.
Medicaid investments in an enhanced primary care program for individuals returning from incarceration are cost neutral and positively impact state budgets by reducing criminal justice system costs.
在过去几十年中，美国刑事司法系统的成本呈指数级增长，为刑满释放人员提供医疗保健成本高昂。为了更好地了解如何管理州预算中针对曾被监禁人员的成本，我们旨在评估一项强化初级保健计划——过渡诊所网络（TCN）——针对近期从监狱释放的慢性病患者和老年人的州级成本。
我们将康涅狄格州惩教部、医疗补助计划以及心理健康与成瘾服务部的行政数据相链接，以确定一个倾向匹配对照组，并估算2013年至2016年间为从监禁中释放的慢性病患者和老年人提供初级保健计划的成本。我们将94名在TCN计划中接受护理的刑满释放人员与94名未在TCN计划中接受护理的刑满释放人员在众多特征上进行匹配。符合TCN计划参与资格的人员在过去6个月内刑满释放，且患有慢性健康状况或年龄超过50岁。我们估算了1）与TCN计划相关的成本，以及2）医疗补助计划和刑事司法系统产生的成本。我们使用非参数自抽样法的双变量分析评估了12个月期间计划参与与医疗补助计划及刑事司法系统成本之间的关联。
12个月的TCN计划运营成本估计为54,394美元（每位参与者每月146美元）。TCN组（1737 ± 3449美元）和对照组（1356 ± 2530美元）每位参与者的平均每月医疗补助成本在统计学上无差异。与匹配组（1276 ± 1738美元，p < 0.05）相比，TCN组每位参与者的平均每月刑事司法系统成本显著更低（733 ± 1130美元）。我们估计，对TCN计划每投入1美元，该州可获得12个月2.55美元的回报。
医疗补助计划对为刑满释放人员提供的强化初级保健计划的投资成本持平，并通过降低刑事司法系统成本对州预算产生积极影响。
