Gender Differences and the Effect of Copayments on the Utilization of Health Care in Prison

Abstract

This study examines differences in episodic health care utilization related to copayment fees in prison.Copayments in correctional institutions may affect men and women differently, as there are gender-specific health needs, differences in the frequencies men and women require medical services, and gendered differences in the financial resources at people's disposal inside the prison environment. Survey data and interviews from 140 males and females incarcerated across two prisons revealed copayments were a significant barrier for those seeking medical attention and reduced utilization. Results from content analysis and zero-inflated Poisson regression models demonstrated the copayments were a greater barrier to treatment for women compared to men, even when considering one's financial resources. Race and self-reported physical health were also significantly associated with avoiding care due to copayments.

Health, Access to Care, and Financial Barriers to Care Among People Incarcerated in US Prisons

“…23 Among 45 men surveyed in a maximum security prison in 2012, 70% reported avoiding care during the previous 3 months because of a $5 co-payment 25 ; a subsequent study based on an apparently overlapping sample of 140 men and women yielded similar findings and suggested that co-payments particularly penalized women, people of racial and ethnic minority groups, and those in poor health. 26 US Centers for Disease Control and Prevention investigators concluded that co-payments (along with poor access to soap) contributed to several prison outbreaks of methicillinresistant Staphylococcus infections. 24 A recent review suggested that co-payments constitute additional and excessive punishment and endanger health.…”

“…[17][18][19][20] People who are incarcerated have some of the lowest incomes in the US, with prison jobs paying as little as $0.04/ per hour (and in some cases are unpaid), 21 and small studies suggest that prison co-payments may be associated with reduced care use. [22][23][24][25][26] Yet, to our knowledge, no nationwide studies have assessed the association between co-payments and care receipt in prisons. We analyzed the most recent publicly available national survey on prison health, which was conducted in 2016 (released in late 2021), to evaluate the prevalence (and changes since 2004) of health conditions likely to require care, receipt of care among prison residents with such conditions, and the association between co-pays and failure to receive care.…”

Cancer incidence among incarcerated and formerly incarcerated individuals: A statewide retrospective cohort study

“…Factors such as lack of access to screening due to security concerns, cost of screening modalities in stretched correctional health budgets, lack of insurance coverage for incarcerated persons, and staffing constraints, may contribute to low screening rates during incarceration. Additionally, though correctional systems are constitutionally required to provide health care to individuals under their custody, institutional policies such as co‐pays may deter individuals from seeking care 30 . Also, mistrust in the health system, competing social needs with a lesser priority on health care and delays in seeking care could contribute to the observed lower incidence of screen‐detectable cancer in the immediate postrelease period 31,32 …”

“…Additionally, though correctional systems are constitutionally required to provide health care to individuals under their custody, institutional policies such as co-pays may deter individuals from seeking care. 30 Also, mistrust in the health system, competing social needs with a lesser priority on health care and delays in seeking care could contribute to the observed lower incidence of screendetectable cancer in the immediate postrelease period. 31,32 The incidence of screen-detectable cancers was higher in non-Hispanic Black persons compared with non-Hispanic White persons in the general population.…”