How the Prison System Affects the Health Care System

United States incarceration rates have increased fivefold in the past four decades, placing untold pressures on other social institutions. Using state- and individual-level data, this article tests whether the number of former inmates affects the functioning and quality of the health care system. The aggregate-level results show that a within-state increase in the number of former inmates is associated with growth in the uninsured population, more frequent use of emergency rooms per capita, and a decline in the supply of hospital beds. Similarly, states that incarcerate more people also report fewer ambulatory visits per capita, fewer mammograms, and lower levels of essential diagnostic tests among diabetic Medicare enrollees, all indicators of a lower overall quality of care. Similar processes are evident even when examining behavioral outcomes in individual-level data.  Results from a nationally representative survey, show that individuals residing in states with a large number of former inmates report more unmet need, lower utilization, and lower quality care.  These patterns are found even among those far removed from the prison system, including women, the insured, and the well-educated.  The implications of broad spillovers from the prison system to the health care system are discussed