Who’s Minding Prison-Healthcare Expenditures?

Source: “Prison Health Care Costs and Quality,” The Pew Charitable Trusts

The finding that New Mexico spends more on prison-inmate healthcare than every state but California and Vermont offers more evidence that sound fiscal stewardship is rather rare in the Land of Enchantment.

Perhaps most frustrating, though, is the fact that we don’t know precisely why expenditures are so out-of-whack. And the problem is hardly limited to New Mexico. Researchers at The Pew Charitable Trusts discovered that many states have “a limited ability to dig deep into their spending data” on corrections healthcare. Asked to separate into line items “modeled after those used by the Centers for Medicare & Medicaid Services to examine and report national health care expenditures writ large,” not a single state was able to submit data for “all 22 categories requested.” Even worse, “health care quality measurement and monitoring” is lacking. Not surprisingly, most prisons systems emphasize “measurement of process over outcomes.”

One clear conclusion from Pew’s work is that contracting out prison healthcare is not correlated with big expenditures. Seventeen states, including Oklahoma and Utah, run government-only systems. Twenty states, including New Mexico and Arizona, contract out. Eight states operate hybrid systems, and four charge their universities with providing medical services. High, mid-range, and low costs can be found with each types of approach. (And it’s worth noting that Pew did not explore “health care provided to those individuals in the jurisdiction of [New Mexico’s] corrections department who are held in the custody of private prisons,” who accounted for 50.2 percent of the state’s “average daily population.”)

Last year, New Mexico chose not to renew its contract with Corizon Correctional Healthcare, and awarded a one-year deal to Centurion Managed Care. The incumbent had more than a few problems — including a multitude of inmate lawsuits. But as an investigation by the Santa Fe New Mexican disclosed, whatever the company’s competency issues, oversight by the New Mexico Corrections Department was appallingly weak. Reporter Phaedra Haywood and Justin Horwath found that “department officials sometimes went years without auditing Corizon,” employee warnings “about short staffing, substandard care and a lack of auditing went unheeded,” and that “the number of people assigned to monitor Corizon’s performance shrank from four medical professionals to one lawyer.” The paper’s exposé provided a valuable reminder that outsourcing government services only works when public-sector officials closely monitor contractors.

Pew’s exploration of prison-healthcare cost drivers suggests that no matter how services are provided in New Mexico, expenditures are likely to be substantial. One reason is behavioral health. With mental illness and substance abuse so widespread in the state, it’s only natural that the corrections system will have many inmates in need of costly treatments. In addition, New Mexico has a relatively large share of female prisoners, who Pew reports “tend to have outsized and sometimes costly health needs.”

One area in need of immediate attention is staffing. As the chart above shows, in 2015, “doing more with less” was not a priority for Corizon and its Corrections Department overseers. New Mexico suffered from the worst personnel-to-inmate ratio in the country.

Improved contract monitoring is a must. In addition, bail reform, better behavioral-health policies, and decriminalization of nonviolent “offenses” promise real savings in prison healthcare. “Measurement of process over outcomes” needs to go. Finally, can anything be learned from private-prison operators in New Mexico?

November 6 update: The Santa Fe New Mexican has discovered a flaw in Pew’s math — here are the details. We’ll wait for the report to be corrected, but cutting New Mexico’s numbers in half still yields some rather high figures. Staffing goes down to 43.4, but that’s above Texas, Arizona, and Oklahoma. (No data available for Utah, apparently.) Costs go down to $6,147, but that’s above four of our five neighbors. (Both modified metrics are essentially tied with Colorado.)

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