Department of Medicine, Cambridge Health Alliance, Cambridge, Massachusetts.
Harvard Medical School, Boston, Massachusetts.
JAMA Intern Med. 2024 Oct 1;184(10):1176-1184. doi: 10.1001/jamainternmed.2024.3567.
Decades-old data indicate that people imprisoned in the US have poor access to health care despite their constitutional right to care. Most prisons impose co-payments for at least some medical visits. No recent national studies have assessed access to care or whether co-pays are associated with worse access.
To determine the proportion of people who are incarcerated with health problems or pregnancy who used health services, changes in the prevalence of those conditions since 2004, and the association between their state's standard prison co-payment and care receipt in 2016.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional analysis was conducted in October 2023 and used data from the Bureau of Justice Statistics' 2016 Survey of Prison Inmates, a nationally representative sample of adults in state or federal prisons, with some comparisons to the 2004 version of that survey.
The state's standard, per-visit co-payment amount in 2016 compared with weekly earnings at the prison's minimum wage.
Self-reported prevalence of 13 chronic physical conditions, 6 mental health conditions, and current severe psychological distress assessed using the Kessler Psychological Distress Scale; proportion of respondents with such problems who did not receive any clinician visit or treatment; and adjusted odds ratios (aORs) comparing the likelihood of no clinician visit according to co-payment level.
Of 1 421 700 (unweighted: n = 24 848; mean [SD] age, 35.3 [0.3] years; 93.2% male individuals) prison residents in 2016, 61.7% (up from 55.9% in 2004) reported 1 or more chronic physical conditions; among them, 13.8% had received no medical visit since incarceration. A total of 40.1% of respondents reported ever having a mental health condition (up from 24.5% in 2004), of whom 33.0% had received no mental health treatment. A total of 13.3% of respondents met criteria for severe psychological distress, of whom 41.7% had not received mental health treatment in prison. Of state prison residents, 90.4% were in facilities requiring co-payments, including 63.3% in facilities with co-payments exceeding 1 week's prison wage. Co-payments, particularly when high, were associated with not receiving a needed health care visit (co-pay ≤1 week's wage: aOR, 1.43; 95% CI, 1.10-1.86; co-pay >1 week's wage: aOR, 2.17; 95% CI, 1.61-2.93).
This cross-sectional study found that many people who are incarcerated with health problems received no care, particularly in facilities charging co-payments for medical visits.
尽管美国囚犯享有宪法规定的医疗保健权利，但几十年前的数据表明，他们获得医疗保健的机会很差。大多数监狱对至少部分医疗访问收取共同支付费用。最近没有全国性的研究评估获得医疗服务的情况，也没有评估共同支付费用是否与较差的获得医疗服务的机会有关。
确定患有健康问题或怀孕的被监禁者中使用医疗服务的比例、自 2004 年以来这些疾病的流行率变化，以及 2016 年其所在州标准监狱共同支付与获得护理之间的关系。
设计、设置和参与者：这是一项 2023 年 10 月进行的横断面分析，使用了美国司法部统计局 2016 年囚犯调查的数据，该调查是一项针对州或联邦监狱中成年人的全国代表性样本，其中一些数据与该调查的 2004 年版本进行了比较。
2016 年，每个就诊的州标准共同支付金额与监狱最低工资的每周收入相比。
使用 Kessler 心理困扰量表评估的 13 种慢性身体状况、6 种心理健康状况和当前严重心理困扰的自我报告流行率；没有接受任何临床就诊或治疗的受访者中存在这些问题的比例；以及根据共同支付水平比较没有临床就诊可能性的调整后优势比（aOR）。
在 2016 年的 1421700 名（未加权：n=24848；平均[标准差]年龄，35.3[0.3]岁；93.2%为男性）监狱居民中，61.7%（高于 2004 年的 55.9%）报告患有 1 种或多种慢性身体状况；其中，13.8%自入狱以来从未接受过医疗就诊。共有 40.1%的受访者报告曾患有心理健康问题（高于 2004 年的 24.5%），其中 33.0%未接受过心理健康治疗。共有 13.3%的受访者符合严重心理困扰的标准，其中 41.7%在监狱中未接受心理健康治疗。在州监狱居民中，90.4%的人在需要共同支付费用的设施中，其中 63.3%的人在共同支付费用超过 1 周监狱工资的设施中。共同支付，特别是当金额较高时，与未接受所需医疗保健就诊有关（共同支付≤1 周工资：aOR，1.43；95%CI，1.10-1.86；共同支付>1 周工资：aOR，2.17；95%CI，1.61-2.93）。
这项横断面研究发现，许多患有健康问题的囚犯没有得到治疗，特别是在对医疗访问收取共同支付费用的设施中。
