Federal Prisons: Responses to Questions Related to Containing Health Care Costs for an Increasing Inmate Population Page: 4 of 8
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expenses. BOP suggested this alternative because an administrative process is already in
place that could be modified at little or no cost to include tracking collected fees. However,
the cost of distributing restitution checks to victims is another matter since no administrative
process or supporting staff structure currently exists. One BOP official told us that the
number of checks could be enormous, the amount of each check would be small, and the
administrative cost of establishing and maintaining a process (to make sure victims received
the appropriate checks) would be an additional expense. This official also opined that victims
might react negatively to receiving checks of such small amounts repeatedly over the years.
CBO has looked at this question of unnecessary or frivolous medical visits. CBO reported that
where similar prisoner copayment programs were adopted in 36 states or local jurisdictions,
prison medical facilities experienced average reductions in sick call visits of 16 percent to 50
percent. We received anecdotal information from BOP health care officials that frivolous
visits to medical units do occur in BOP and that some reduction in this kind of abuse can be
anticipated if additional charges are levied. However, we have not independently verified the
magnitude of such a reduction.
Neither BOP nor we believe that the primary benefit of the copayment proposal is to generate
revenue. Rather, its primary benefit would be to reduce unnecessary or frivolous medical
visits and the burden that such visits place on BOP medical staff. Given the projected
increase in the prison population through 2006, it appears the demands on BOP's health care
system will increase.
Question 6. Have the administrative initiatives that BOP put into place over the
last several years to contain inmate health care costs and increase efficiency of
services been taken into account by your estimate? Have the facts or assumptions
on which you based your estimate of $1 million changed?
The estimates of increased efficiency of services by virtue of administrative initiatives BOP
has undertaken over the last several years are BOP estimates. The $1 million estimate of
anticipated revenue generated by a prisoner copayment provision is CBO's estimate. We
referred to the CBO estimate in our testimony because we did not want to duplicate that
work. Also, given the short time in which we conducted our review, we did not attempt to
independently verify the estimates and do not know whether the facts and assumptions used
by CBO have changed.
BOP officials believe that savings or benefits from the economy and efficiency initiatives BOP
has implemented will eventually bottom out and they expect that inmate health care costs
will rise given
* the pressures from a growing prison population;
* transfers of inmates to BOP from the District of Columbia Department of Corrections-
inmates who generally have disproportionately more medical needs than other BOP inmates;
* the increase in numbers of long-term, nonreturnable detainees from INS; and
* the growth in expenditures for pharmaceuticals because of the increasing prevalence of
illnesses such as HIV and hepatitis.
GGD-00-160R Questions About Inmate Health Care Costs
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United States. General Accounting Office. Federal Prisons: Responses to Questions Related to Containing Health Care Costs for an Increasing Inmate Population, text, June 14, 2000; Washington D.C.. (digital.library.unt.edu/ark:/67531/metadc298486/m1/4/: accessed January 16, 2019), University of North Texas Libraries, Digital Library, digital.library.unt.edu; crediting UNT Libraries Government Documents Department.