{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,25]],"date-time":"2026-10-25T19:54:05Z","timestamp":1792958045009,"version":"4.5.0"},"reference-count":71,"publisher":"American Medical Association (AMA)","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Intern Med"],"published-print":{"date-parts":[[2024,10,1]]},"abstract":"<jats:sec id=\"ab-ioi240046-4\"><jats:title>Importance<\/jats:title><jats:p>Decades-old data indicate that people imprisoned in the US have poor access to health care despite their constitutional right to care. Most prisons impose co-payments for at least some medical visits. No recent national studies have assessed access to care or whether co-pays are associated with worse access.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ioi240046-5\"><jats:title>Objective<\/jats:title><jats:p>To determine the proportion of people who are incarcerated with health problems or pregnancy who used health services, changes in the prevalence of those conditions since 2004, and the association between their state\u2019s standard prison co-payment and care receipt in 2016.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ioi240046-6\"><jats:title>Design, Setting, and Participants<\/jats:title><jats:p>This cross-sectional analysis was conducted in October 2023 and used data from the Bureau of Justice Statistics\u2019 2016 Survey of Prison Inmates, a nationally representative sample of adults in state or federal prisons, with some comparisons to the 2004 version of that survey.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ioi240046-7\"><jats:title>Exposures<\/jats:title><jats:p>The state\u2019s standard, per-visit co-payment amount in 2016 compared with weekly earnings at the prison\u2019s minimum wage.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ioi240046-8\"><jats:title>Main Outcomes and Measures<\/jats:title><jats:p>Self-reported prevalence of 13 chronic physical conditions, 6 mental health conditions, and current severe psychological distress assessed using the Kessler Psychological Distress Scale; proportion of respondents with such problems who did not receive any clinician visit or treatment; and adjusted odds ratios (aORs) comparing the likelihood of no clinician visit according to co-payment level.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ioi240046-9\"><jats:title>Results<\/jats:title><jats:p>Of 1\u202f421\u202f700 (unweighted: n\u2009=\u200924\u202f848; mean [SD] age, 35.3 [0.3] years; 93.2% male individuals) prison residents in 2016, 61.7% (up from 55.9% in 2004) reported 1 or more chronic physical conditions; among them, 13.8% had received no medical visit since incarceration. A total of 40.1% of respondents reported ever having a mental health condition (up from 24.5% in 2004), of whom 33.0% had received no mental health treatment. A total of 13.3% of respondents met criteria for severe psychological distress, of whom 41.7% had not received mental health treatment in prison. Of state prison residents, 90.4% were in facilities requiring co-payments, including 63.3% in facilities with co-payments exceeding 1 week\u2019s prison wage. Co-payments, particularly when high, were associated with not receiving a needed health care visit (co-pay \u22641 week\u2019s wage: aOR, 1.43; 95% CI, 1.10-1.86; co-pay &amp;amp;gt;1 week\u2019s wage: aOR, 2.17; 95% CI, 1.61-2.93).<\/jats:p><\/jats:sec><jats:sec id=\"ab-ioi240046-10\"><jats:title>Conclusions and Relevance<\/jats:title><jats:p>This cross-sectional study found that many people who are incarcerated with health problems received no care, particularly in facilities charging co-payments for medical visits.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamainternmed.2024.3567","type":"journal-article","created":{"date-parts":[[2024,8,5]],"date-time":"2024-08-05T16:40:04Z","timestamp":1722876004000},"page":"1176","source":"Crossref","is-referenced-by-count":40,"title":["Health, Access to Care, and Financial Barriers to Care Among People Incarcerated in US Prisons"],"prefix":"10.1001","volume":"184","author":[{"given":"Emily Lupton","family":"Lupez","sequence":"first","affiliation":[{"name":"Department of Medicine, Cambridge Health Alliance, Cambridge, Massachusetts"},{"name":"Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steffie","family":"Woolhandler","sequence":"additional","affiliation":[{"name":"Harvard Medical School, Boston, Massachusetts"},{"name":"City University of New York at Hunter College, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David U.","family":"Himmelstein","sequence":"additional","affiliation":[{"name":"Harvard Medical School, Boston, Massachusetts"},{"name":"City University of New York at Hunter College, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Hawks","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee"},{"name":"Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel","family":"Dickman","sequence":"additional","affiliation":[{"name":"Planned Parenthood of Montana, Kalispell"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam","family":"Gaffney","sequence":"additional","affiliation":[{"name":"Department of Medicine, Cambridge Health Alliance, Cambridge, Massachusetts"},{"name":"Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Bor","sequence":"additional","affiliation":[{"name":"Department of Medicine, Cambridge Health Alliance, Cambridge, Massachusetts"},{"name":"Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"Schrier","sequence":"additional","affiliation":[{"name":"University of California\u2013San Francisco School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chris","family":"Cai","sequence":"additional","affiliation":[{"name":"Department of Medicine, Brigham and Women\u2019s Hospital, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lenore S.","family":"Azaroff","sequence":"additional","affiliation":[{"name":"Edward M. 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Accessed March 17, 2024. https:\/\/www.congress.gov\/bill\/118th-congress\/senate-bill\/1165#:~:text=This%20bill%20allows%20for%20Medicaid,period%20preceding%20the%20individual's%20release."}],"container-title":["JAMA Internal Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamainternalmedicine\/articlepdf\/2821730\/jamainternal_lupez_2024_oi_240046_1727970862.70355.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,10,7]],"date-time":"2024-10-07T15:02:51Z","timestamp":1728313371000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamainternalmedicine\/fullarticle\/2821730"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,10,1]]},"references-count":71,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2024,10,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamainternmed.2024.3567","relation":{},"ISSN":["2168-6106"],"issn-type":[{"value":"2168-6106","type":"print"}],"subject":[],"published":{"date-parts":[[2024,10,1]]}}}