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Sarah K.S. Shannon
Suzy Maves McElrath
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Context: This study examines the spillover effects of growth in state-level incarceration rates on the functioning and quality of the US health care system.
Methods: Our multilevel approach first explored cross-sectional individual level data on health care behavior merged to aggregate state-level data regarding incarceration. We then conducted an entirely aggregate-level analysis to address between-state heterogeneity and trends over time in health care access and utilization.
Findings: We found that individuals residing in states with a larger number of former prison inmates have diminished access to care, less access to specialists, less trust in physicians, and less satisfaction with the care they receive. These spillover effects are deep in that they affect even those least likely to be personally affected by incarceration, including the insured, those over 50, women, non-Hispanic whites, and those with incomes far exceeding the federal poverty threshold. These patterns likely reflect the burden of uncompensated care among former inmates, who have both a greater than average need for care and higher than average levels of uninsurance. State-level analyses solidify these claims. Increases in the number of former inmates are associated simultaneously with increases in the percentage of uninsured within a state and increases in emergency room use per capita, both net of controls for between-state heterogeneity.
Conclusions: Our analyses establish an intersection between systems of care and corrections, linked by inadequate financial and administrative mechanisms for delivering services to former inmates.
Author(s): Jason Schnittker, Christopher Uggen, Sarah K.S. Shannon, and Suzy Maves McElrath
Keywords: spillover, incarceration, health care
Read on Wiley Online Library
Volume 93, Issue 3 (pages 516–560) DOI: 10.1111/1468-0009.12136 Published in 2015
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The Milbank Quarterly’s multidisciplinary approach and commitment to applying the best empirical research to practical policymaking offers in-depth assessments of the social, economic, political, historical, legal, and ethical dimensions of health and health care policy.