Report Based on Self-Reported Data From States. In October 2017, the Pew Charitable Trusts released a report comparing how much each state spends on inmate health care, including medical, mental health, and dental care. The report relied on state surveys completed based on data from 2014‑15. A total of 49 states responded to the survey. The report cautions that each state self-reported data, which makes it difficult to determine whether all states collected data the same way. Despite this, the report provides some insight into how California compares to other states with respect to inmate health care costs.
California’s Health Care Costs Per Inmate Reported to Be Highest in the Nation. As shown in Figure 1, California averaged the highest health care costs per inmate in 2014‑15 at $19,796 per inmate. The national average was $6,352 per inmate. (We note that these amounts did not include facility costs or health care costs for inmates supervised in contract facilities.) When Pew previously conducted this survey in 2009‑10, California also had the highest health care costs per inmate of reporting states.
California’s Inmate Health Care Costs Grew Among Fastest in Nation. In addition to having the highest inmate health care costs, California’s costs (on a per inmate basis) grew significantly faster since 2009‑10 than the national average—25 percent versus 3 percent nationwide. While 26 other states reported an increase in inmate health care costs, Louisiana was the only state whose costs increased at higher rate than California. We note that 19 states actually reported a decline in per inmate health care costs.
California’s High Inmate Health Care Costs Due to Various Factors. For decades California has been under various forms of court supervision related to its provision of inmate medical, mental health, and dental care. For example, after finding the state failed to provide a constitutional level of medical care to inmates, the federal court appointed a Receiver in 2006 to take control over the direct management of the state’s prison medical care delivery system. The different forms of court supervision related to inmate health care have resulted in changes that increased how much the state spends on such care. A few of these major changes include:
Relatively High Staffing. California has been required to increase the amount of health care staff at its prisons. In 2014‑15, the state employed 70 full-time equivalents (FTEs) per 1,000 inmates, which was the fourth highest in the nation. New Mexico had the highest staffing with 87 FTEs per 1,000 inmates. As shown by Figure 2, staffing ratios vary greatly across the nation.
Increased Employee Compensation. Requirements to increase the amount paid to various health care workers to help facilitate recruitment also played a role in California’s high costs. While the Pew report did not compare employee compensation across different health care professions, it did suggest that differences in employee compensation could account for a portion of the overall difference in inmate health care costs. Based on differences in advertised salaries for vacant correctional physician positions, California does appear to have high physician pay compared to some states. For example, salaries for correctional physicians in California appeared to exceed those advertised in North Carolina by over 30 percent. This could be for a variety of factors, such as differences in the cost-of-living.
Other Requirements. The different court orders have also required California to make other inmate health care improvements that have resulted in additional costs. For example, California has been directed by the federal court to treat a greater proportion of Hepatitis C patients compared to some other states as well as improve its medical equipment.