New Prison Policy Initiative report explains notoriously bad correctional healthcare

February 19, 2025

Why are terrible prison and jail healthcare systems so resilient against lawsuits and government oversight? How do healthcare providers cut corners with patient care to keep costs down? When and why did corrections agencies start to swing towards contracting out healthcare to companies?

In a new report, Cut-Rate Care, the Prison Policy Initiative answers these questions and others, providing a sweeping explainer of correctional healthcare. We focus on the incentives behind notoriously bad care found in prisons, and explain the major changes — in particular, a shift away from control of healthcare by departments of corrections — that would be necessary to reorient these systems toward a public health approach to care.

People in prison have unique health needs, suffering disproportionately from illnesses like Hepatitis C, HIV, and substance use disorder. As we’ve shown before, these needs routinely go unmet in prisons. Our new report explains why: Correctional healthcare systems are services for corrections departments, not incarcerated people, and are therefore focused less on patient care and more on avoiding lawsuits.

The explainer covers:

• The ways prisons protect themselves against legal consequences for poor medical care, from contracts that offload responsibility onto private companies to federal and state laws that stymie legal action.
• The history of privatization in prison healthcare, including a table showing the three main business models of healthcare contracts in effect in prisons today.
• The few quality control measures for prison healthcare — government oversight, accreditation, and litigation — and why these have all ultimately failed to meaningfully improve the quality of care.

“With prison healthcare, you regularly see that incarcerated people’s complaints get ignored, their requests for exams get denied, and their care gets slow-walked,” said author Brian Nam-Sonenstein. “That’s because prison healthcare systems are really more like liability management systems, and what’s bad for patient care can actually be good for limiting liability.”

Beyond offering an overview of correctional healthcare, the explainer also includes:

• Policy recommendations for decision-makers at all levels of government, but particularly for state and federal lawmakers — whom we urge to remove the provision of prison healthcare from departments of corrections and transfer it to public health agencies, breaking down the “wall” that currently exists between correctional healthcare and public health.
• An appendix with a thumbnail history of the evolution of correctional healthcare, centered around the pivot to privatization since the turn of the millennium.
• Anecdotes from six incarcerated people (in six different prison systems) whom we asked about their experiences with correctional healthcare.

“Private or public, the goal of prison healthcare providers is to provide the minimum amount of care possible in order to avoid claims of negligence,” said Nam-Sonenstein. “These are medical systems caught up not just culturally, but systemically, with the handing out of punishment. That won’t change until we take correctional healthcare out of the hands of departments of corrections and give it to professionals who are solely focused on public health.”

The full report is available at: https://www.prisonpolicy.org/reports/healthcare.html.