Texas Health Care Cited as National Model

GALVESTON, Texas ? A recent study by the Journal of the American Medical Association concludes that a new health-care program in Texas prisons has both improved the quality of care and reduced costs.

Ten years ago, the Texas Department of Criminal Justice (TDCJ) contracted with the University of Texas Medical Branch (UTMB) to provide 78 percent of care for the state?s inmates. Another 22 percent were treated through the Texas Tech University Health Sciences Center.

A prison hospital at UTMB, built in 1983, was the first prison hospital to be located on an academic medical center campus. Specialized treatment programs at different prison units use telemedicine to consult specialists.

Under the new system, several levels of care are provided, including primary ambulatory care clinics on site at the prisons, 16 infirmaries throughout the state, and regional medical facilities.

The program resulted in higher overall compliance with standards of care, from 40.1 percent in 1994 to 96.8 percent in 2003, according to the study. In addition, the mean blood-glucose level for patients with type-1 diabetes decreased, as did cholesterol levels and the proportion of patients with high blood pressure.

Furthermore, the rate of AIDS-related deaths decreased from a high of 1.5 deaths per 1,000 inmates in 1995 to 0.24 deaths per 1,000 in 2002. And the rate for asthma-related deaths went from a high of 3.3 per 100,000 prisoners in 1995 to zero in 2002.

According to one study of Texas inmates incarcerated between August 1997 and July 1998, 60 percent of the prisoners were diagnosed with at least one medical condition, including asthma, diabetes, hepatitis, HIV and various psychiatric conditions.

The TDCJ program has resulted in an estimated savings of $750 million over 10 years, according to the study. With 145,000 inmates, the TDCJ spends $315 million a year on health care, compared with $1 billion in California, which houses about 160,000 inmates. California?s prison system is among those currently evaluating the program.

The study appears in the July 28 issue of the AMA Journal. Dr. Ben Raimer, chief physician executive and vice president of correctional managed health care at UTMB in Galveston, was lead author of the study.

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