摘要：Objectives. People who are incarcerated exhibit high rates of disease, but data evaluating the delivery of medical services to inmates are sparse, particularly for jail settings. We sought to characterize the primary medical care providers for county jail inmates in New York State. Methods. From 2007 through 2009, we collected data on types of medical care providers for jail inmates in all New York State counties. We obtained data from state monitoring programs and e-mail questionnaires sent to county departments of health. Results. In counties outside New York City (n = 57), jail medical care was delivered by local providers in 40 counties (70%), correctional medical corporations in 8 counties (14%), and public providers in 9 counties (16%). In New York City, 90% of inmates received medical care from a correctional medical corporation. Larger, urban jails, with a greater proportion of Black and Hispanic inmates, tended to use public hospitals or correctional medical corporations as health care vendors. Conclusions. Jail medical services in New York State were heterogeneous and decentralized, provided mostly by local physician practices and correctional medical corporations. There was limited state oversight and coordination of county jail medical care. In 1976, the US Supreme Court issued a landmark decision, Estelle v Gamble, granting prisoners a constitutional right to standard-of-care medical services. 1 In fact, prisoners are the only civilian subgroup in the United States with a constitutionally guaranteed right to health care. Delivering medical care to inmates and ensuring continuity of care after release are logistically complex and costly endeavors. A recent nationwide survey found high rates of medical and psychiatric conditions among US prisoners, with nearly 70% of inmates reporting at least 1 chronic illness. 2 The challenges of providing standard-of-care medical services to prisoners are manifold. In most states, the correctional system is 2-tiered, composed of prisons and jails. Prisons hold sentenced inmates for periods of a year or longer; jails confine pretrial detainees and inmates sentenced to periods of less than 1 year. Jails pose particular challenges to health care delivery because of the large volume and rapid turnover of inmates. These challenges include discontinuity of care, 3 lack of timely access to medical records, lack of trust between patient and provider, 4 withdrawal from addictive substances, 5 poor discharge planning, 6 and loss of medical insurance. 7 Unfortunately, data evaluating the delivery of medical services to inmates are sparse, particularly in jail settings. In the neglected field of prison health research, jails constitute a doubly marginalized domain for evaluation and advocacy. Since the 1970s, US incarceration rates have increased dramatically, with 2.3 million people incarcerated in jails and prisons at the end of 2008. 8 An estimated 9 million individual inmates are admitted to and released from jail annually. 9 This volume represents an enormous population of medically and psychiatrically vulnerable individuals circulating through the nation's jails. The delivery of health services within the correctional system ultimately depends on the availability of trained medical care providers. In general, correctional facilities do not constitute a broadly attractive practice setting for most physicians. Prisoners' health needs are not routinely addressed in medical or nursing school curricula. 10 After a careful review of publicly available information, we were unable to find any comprehensive information describing the sector (public vs private providers) or training level of medical care providers for any US state. Nor were we able to identify any comprehensive surveys of health care providers for county jail inmates in the medical, social science, or popular literature. The popular press has addressed the issue of correctional medical care through a focus on privatization of these services. 11 , 12 However, analyses characterizing medical service providers for inmates have not been published. We conducted a statewide survey of medical care providers for county jail inmates, using New York State (NYS) as our study setting. The aim of our study was to determine who provided primary medical care to county jail inmates in NYS. To our knowledge, this is the first statewide study attempting to characterize providers of medical care to county jail inmates.
