The Hidden Health Care Crisis Behind Bars: A Randomized Trial to Accredit U.S. Jails

Marcella Alsan and Crystal Yang

No 33357, NBER Working Papers from National Bureau of Economic Research, Inc

Abstract: The U.S. has one of the highest incarceration rates in the world, with over seven million admissions to jails each year. Incarcerated individuals are the only group in the U.S. that have a constitutional right to receiving “reasonably adequate” health care. Yet, there is little oversight and funding for health care in jails, where adverse health outcomes such as mortality are known to be underreported. This setting is also one characterized by limited information among law enforcement regarding health care standards, and coordination problems between custody and medical staff who together produce inmate health. We randomize the offer of health care accreditation, which provides education and training on evidence-based industry standards, to 44 jails across the U.S. We find accreditation improves quality standards and reduces mortality among the incarcerated, which is three times higher among control facilities than official estimates suggest. Surveys of staff indicate that accreditation improves coordination between health and custody staff, and audits of medical records find enhanced screening of inmates upon admission. These health gains are realized alongside suggestive reductions in six-month recidivism, such that accreditation is highly cost effective.

JEL-codes: I1 I14 I18 I3 K10 K14 (search for similar items in EconPapers)
Date: 2025-01
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