Federal Prisons:

Responses to Questions Related to Containing Health Care Costs for an Increasing Inmate Population

GGD-00-160R: Published: Jun 14, 2000. Publicly Released: Jul 14, 2000.

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Pursuant to a congressional request, GAO responded to congressional questions on its April 6, 2000, testimony on the Bureau of Prisons (BOP) efforts to contain the costs of providing health care to inmates, focusing on whether: (1) requiring a copayment would reduce the number of prisoners seeking medical care in order to get out of work or other duties; (2) recent BOP initiatives have helped reduce staff costs; (3) it would be more cost-effective for BOP to have an intermediate care medical facility for inmates needing long-term care; and (4) the Federal Prisoner Health Care Copayment Act of 1999 would significantly contribute to reducing health care costs.

GAO noted that: (1) in prisons that adopted a prisoner copayment program, prison medical facilities experienced average reductions in sick call visits of 16 percent to 50 percent; (2) BOP health care officials state that frivolous visits to medical units do occur and that some reduction in this kind of abuse could be anticipated if some additional charge were levied; (3) the Congressional Budget Office (CBO) reported that after adopting copayment requirements, 36 states or local jurisdictions experienced reductions in the number of sick call visits; (4) a restructuring initiative that focused on using qualified, lower-salaried medical personnel instead of more highly paid physicians and physicians' assistants for certain routine duties has allowed for more efficient operations; (5) BOP attributed annual savings of about $5.5 million to this initiative; (6) BOP officials expect overall medical costs to continue to rise in future years for several reasons: (a) the number of inmates incarcerated in federal facilities show continued increases; (b) felony inmates transferred to BOP from the District of Columbia Department of Corrections generally have more medical needs than other BOP inmates; (c) BOP is receiving increasing numbers of long-term, nonreturnable detainees from the Immigration and Naturalization Service; and (d) BOP's expenditures for pharmaceuticals likely will rise due to the increasing prevalence of certain illnesses; (7) an intermediate care facility could have advantages for BOP, since medical costs at BOP's medical referral centers are higher on a per inmate basis than medical costs at standard prisons; (8) the estimated medical costs on a per inmate basis at a medical referral center are about $16,000 per year, whereas medical costs at a standard prison are less than $2,500 per year; (9) a May 1999 CBO analysis of the proposed $2 copayment health care service fee estimated that BOP might generate additional revenue of about $1 million in fiscal year 2000; (10) however, BOP endorses the proposed fee primarily as a means to reduce unnecessary or frivolous medical visits; and (11) BOP has suggested that the proposed legislation be modified to mandate that 100 percent of collected fees go to the Federal Crime Victims Fund.

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