Prioritization of inpatient hospital services to inmates: A method for justifying costs and meeting constitutional standards

State prison systems are required to maintain a constitutional level of health care despite increasing fiscal challenges. The age and clinical acuity of the prison population continues to increase throughout the nation. As the prison population ages and correctional health care costs continue to rise, funding for the provision of correctional health care often remains static or may even face substantial reductions.;As a response to rising health care costs and substantial cuts in state funding for correctional health care in Texas, a process framework for systematically prioritizing the provision of inpatient hospital services in a correctional setting was developed and applied. Specifically, electronic records of all inpatient services provided to prisoners from September 2010 through August 2012 (Fiscal Years 2011 & 2012) at the University of Texas Medical Branch (UTMB)/Texas Department of Criminal Justice Hospital were reviewed, and all services and related costs were then sorted according to priority levels of care consistent with those previously defined by the Oregon Department of Corrections and the Federal Bureau of Prisons. Services and related costs were subsequently described by level of care and by hospital specialty. Data for this retrospective study were obtained from the hospital electronic medical records. Unique combinations of primary diagnoses and procedure codes from inpatient hospital data for the study period were treated as condition-treatment pairs. The primary diagnosis code for each hospital discharge was then matched to the corresponding diagnosis codes within the Oregon Health Plan Prioritized List to align each case to a specific Oregon Health Plan condition-treatment pair line number. For each match, a condition-treatment review sheet was generated that included the line number along with codes, descriptions, and quantities for the conditions, procedures, and diagnostic related group. Using these review sheets, condition-treatment pairs were sorted by the hospital medical director into the appropriate hospital specialty category. Subsequently, review sheets were independently reviewed and assigned to levels of care by the hospital medical director and by a faculty member from each hospital specialty.;Of the unique inpatients (N=3,041for FY 2011, N=2,702 for FY 2012), a majority of patients (73.5%) had only one inpatient hospital stay, but nearly half of patients (49.6%) were over the age of 50 years. These patients accounted for 8,342 inpatient stays for a total cost of ;Given that nearly all inpatient services (94%) provided to prisoners were medically mandatory or necessary, these services must be funded in order to ensure provision of a constitutionally justifiable standard of care. Capitated funding mechanisms may not support this policy recommendation, and alternative, more flexible funding mechanisms should be considered. Additionally, funding requirements should be expected to increase as the proportion of older inmates continues to increase. The methodology developed for this study may be used by other correctional health care systems to describe and substantiate the provision of hospital inpatient services and to inform State policymakers regarding funding requirements.