Telemedicine is proving itself to be a major factor in keeping healthcare costs contained. Prisons may benefit from the cost-savings of telemedecine.
Telemedicine, or providing healthcare services remotely through the use of store-and-forward medical information, phone calls, emails, and secure video teleconferencing, saves money and time on the part of both the patient and the healthcare provider. Insurers, including government insurers Medicare and Medicaid, as well as the Veterans Administration, are all rapidly learning the advantages of telemedicine and embracing its use.
Another population that is increasingly being served through telemedicine applications is one you might not expect: prisoners. Currently there are around 1.5 million people in prison in the US, and about 700,000 in jails around the country. Delivering healthcare services to these populations presents a variety of challenges and represents a major financial expense.
The 2.2 million people who are incarcerated are overwhelmingly poor, non-white, and male, though there is also an increasing segment of the prison population that is aging behind bars. States are exploring the possibilities of serving the healthcare needs of incarcerated people through telemedicine because of cost, convenience, and safety concerns.
Prevalence of Mental Health and Chronic Health Conditions in Prisons
The state of Georgia has the nation’s fifth largest prison population, and Dr. Sharon Lewis, the Medical Director for the Georgia Department of Corrections, says that 94% are male, 62% are in the 25- to 45-year age group, but half of the prison population is over age 35. Lewis says that 37% of the inmate population, which is distributed among 120 facilities, experiences chronic health conditions, and 17% of inmates receive mental healthcare services.
As Georgia’s prison population ages, more inmates cope with physical problems, immobility, and degenerative illnesses, all while healthcare budgets for inmates are shrinking. Results include poorer healthcare for the incarcerated and increased liability for the prison systems.
A Pew Charitable Trust report from 2013 showed that the cost of providing healthcare to inmates increased by 28% nationally between 2001 and 2008. From 2007 through 2011, the number of prisoners over age 55 increased in most states, increasing by 32% in the state of Texas. Mental health conditions and chronic physical conditions are two major drivers of higher healthcare costs for correctional systems.
Telemedicine and Mental Health Services in Prisons
Approximately 20% of prison inmates have serious mental illnesses, and 30 to 60% have substance abuse problems. There is some overlap between these two populations. Common mental health issues include depression, schizophrenia, bipolar disorder, and self-injury. Many inmates have histories of violence.
Telemedicine is proving to be vital to providing mental healthcare services to inmates, particularly in rural facilities that are simply not equipped to offer such services. Provision of mental healthcare is essential to rehabilitation to those who are incarcerated, and has been shown to reduce violence within prisons.
Moreover, mental health services provided via telemedicine are often less expensive, and save prisons the expense and risk of transporting prisoners to facilities to receive mental health services. An average of $1 million per year per facility could be saved in healthcare costs, reduced staff needs, and reduced costs attributable to violence with telemedicine mental health services for prisoners. With telepsychiatry software, mental healthcare providers don’t have to travel to reach inmates, allowing them to spend more time on actual treating those with mental illnesses.
Telemedicine and Chronic Health Conditions in Prisons
Prison populations also contain significant numbers of people with chronic illnesses, including HIV, hepatitis C, and conditions associated with aging. Telemedicine can be used to address the healthcare needs of these people as well while containing costs. The state of Texas has saved on the costs of dialysis for inmates by using telemedicine to allow one person to conduct appointments with inmates at both of the state’s two dialysis facilities for prisoners. While patients undergo dialysis, they can participate in a video conference with a doctor, who can receive data from the dialysis equipment in real time while consulting with the patient.
Telemedicine can be used to manage chronic conditions like heart failure, diabetes, and chronic obstructive pulmonary disease in prison populations, cutting costs and reducing risks. When prisoners don’t have to be transported to an off-site facility, transportation costs drop, as do risks of prisoners escaping during transport.
The Texas Prison System and Telemedicine
Texas has subcontracted prison healthcare to the University of Texas Medical Branch and Texas Tech University, and telemedicine is used to reduce costs. From 1994 to 2008, telemedicine saved the Texas Department of Criminal Justice $780 million, and those savings are expected to increase as telemedicine technology matures and the services offered via telemedicine expand. Currently, around 100,000 telemedicine visits take place in prisons in Texas every year.
But are the services effective? Since 1994, deaths from HIV in Texas prisons fell 84%, blood pressure control among inmates improved, and blood glucose levels for diabetic prisoners were controlled better. Telemedicine is used along with electronic medical records, preferred drug formularies, and disease management guidelines, and the result has been better cost control and increasing access to care.
In Texas and elsewhere, prisoners’ physiological age tends to correspond with individuals outside prisons who are 10 to 15 years older, and this makes the cost of incarcerating an aging prison population increase rapidly. With annual healthcare costs for inmates 55 and older estimated at $11,000 to $40,000, it makes sense that prisons would turn to telemedicine to attempt to get costs under control.
While telemedicine is a high tech concept, it is increasingly being applied in situations where people do not have high tech lives, including in marginalized populations like prisoners. Prisoners have a constitutional right to adequate medical care, and states must ensure that any cost-containment strategies preserve adequate quality of healthcare to those who are incarcerated. One way they are doing so is by turning to telemedicine to provide services, particularly mental health services and services for prisoners with chronic conditions. The results so far have been promising in terms of results and savings.
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