Just like insurance companies and public health programs, prisons worry that health services might be over-used if the people they serve don't have skin in the game.
A study by the Brennan Center for Justice at New York University finds that 38 states charge prisoners certain fees for medical services. The introduction of fees is an attempt to rein in the growing cost of prison health care on public coffers. A recent study by Pew Charitable Trusts estimated the annual cost of medical services in U.S. prisons to be $7.7 billion.
The fee structures vary dramatically by state, reports Stateline. The study suggests that fees are typically under $20 for doctor visits and that they are often waived if the inmates say they can't afford them. However, Texas charges prisoners up to $100 for a physician visit and Utah charges inmates up to $2,000 for a hospitalization outside of prison.
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The fees are not without critics. Inmates, most of whom are poor and are making next to no money while serving their sentences, will likely forgo treatment if it eats up a big chunk of what little funds they have.
"There are ways to deal with high demand other than co-pays, which are punitive," Robert Greifinger, the former chief medical officer of the New York Department of Corrections, told Stateline.
"It may not seem like a lot of money but, typically, the prisoners are impoverished and, often, so are their families," Greifinger said. "Sometimes, their choices come down to a medical appointment or shampoo."
Indeed, the Brennan Center found that some prisoners finish their sentences with debt from medical expenses.
So far, few states have shown that charging co-pays is effective in reducing costs to taxpayers. California brought in $500,000 from prisoner co-pays in 2014, while it spent $2.2 billion on inmate health services. Michigan similarly brought in $190,000, compared to a budget of $300 million.
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