Privatization and Quality of Carceral Healthcare: A difference-in-differences Analysis of Jails in the United States, 2008-2019

ABSTRACT

This article analyzes the impact of privatization on service quality in a novel context: jail health care. More than 1,000 people die annually while incarcerated in US jails. In recent years, privatization health care for jail inmates has increased, and many journalists have described abuses by private health care providers in jails. Despite longstanding theoretical interest in the (de)merits of privatization, scholars have been silent on jail health care privatization. Difference-in-differences analyses of mortality trends in a panel of more than 500 jails in the United States from 2008–2019 produce little evidence that switching from publicly to privately provided jail health care increases inmate mortality death in the short-run or long-run. Furthermore, in one state with available data, jail medical spending per inmate day increased following medical care privatization, contrary to theoretical predictions. Further research is needed to uncover the determinants of jail mortality and consequences of correctional health care privatization.

KEYWORDS:

• Jail
• healthcare
• privatization
• mortality
• cost

Bullet point summary

• Privatization of health care provision in US jails is increasingly widespread, yet scholars have not studied the impact of jail health care privatization on inmate health outcomes or spending.

• On average, jails which privatized their health care provider did not experience an increase in inmate mortality compared to jails which maintained publicly provided health care.

• Estimated effects of privatization on inmate mortality varied substantially between states, but did not change over time.

• Medical spending per inmate day increased following jail health care privatization.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

1. Using, from Clogg et al. (1995), the formula $z=\frac{\left({\beta }_2-{\beta }_1\right)}{\sqrt{{\left(\mathrm{S}\mathrm{E}{\beta }_1\right)}^2{+}^{}{\left(SE{\beta }_2\right)}^2}}$