Prison health care: is contracting out healthy?

Abstract

US prison health care has recently been in the news and in the courts. A particular issue is whether prisons should contract out for health care. Contracting out has been growing over the past few decades. The stated motivation for this change ranges from a desire to improve the prison healthcare system, sometimes in response to a court mandate, to a desire to reduce costs. This study is a first attempt to quantify the impact of this change on inmate health. As morbidity measures are not readily obtainable, we focus on mortality. More specifically, we use a panel of state prisons from 1979 to 1990 and a fixed effects Poisson model to estimate the change in mortality associated with increase in the percentage of medical personnel employed under contract. In contrast to the first stated aim of contracting, we find that a 13% increase in percentage of medical personnel employed under contract increases mortality by 1.3%.

Outsourcing Public Services: Ownership, Competition, Quality and Contracting

“…26 Bedard and Frech (2009) on the contrary find that mortality has increased in the share of medical personnel employed under contract in US state prisons.…”

Capabilities and Strategic Entrepreneurship in Public Organizations

“…However, there are sound economic reasons to anticipate that there will be pressures on private prison managers for quality shading to reduce costs (Hart et al ., ; Kivleniece and Quelin, ), which would destroy public value as in the upper‐right cell. Long‐term investments by privately governed prisons to perform on dimensions such as education, drug reformation, and health care services may be greatly curtailed (Bedard and Frech, ) by expressing balanced public objectives in contracts that cede responsibility to private organizations. When such complex objectives cannot be managed, then privatization may simply be too risky to tolerate.…”

Cheap and Dirty: The Effect of Contracting Out Cleaning on Efficiency and Effectiveness

“…However, the profit motive also means that contractors have an incentive to drive down their costs of service provision, either through lowering effort (shirking) or lowering quality (quality shading), especially when these are hard to define ex‐ante or monitor ex‐post. These two competing effects have led to mixed results from contracting out in practice (Bedard and Frech ; Domberger, Hall, and Li ).…”