Although, as noted above, the United States spends approximately six billion dollars per year in correctional health services, it is unclear whether these expenditures are as cost-effective as they could be. ^[1]   Major health delivery financing initiatives are required to merge the missions and harmonize the work of correctional health and community health professionals. By coordinating institution-based efforts with those of community-based service providers, jurisdictions across the country could not only realize a better return on their investment, but also begin to build capacity in communities currently unable to meet the health care needs of their residents. (See Policy Statement 4, Funding a Re-Entry Initiative, and Policy Statement 5, Promoting Systems Integration and Coordination, for additional discussion of how such coordination could be effected.)

Innovative partnerships with community-based organizations such as universities, hospitals, and substance abuse programs enable correctional facilities to both improve the quality of care that they provide and reduce costly duplication of resources. For instance, by collaborating with outside providers, a correctional facility can provide basic health histories and other information gleaned through the intake process to these collaborators. In turn, the correctional facility can gain access to a variety of medical specialties and procedures that it cannot afford to provide on its own. Moreover, when a provider cares for a patient while he or she is a prisoner, the provider-patient relationship that develops can continue when he or she returns to the community, providing personal and public health benefits.

Example: Project Bridge, Miriam Hospital (RI)

Project Bridge offers a holistic social support model based upon a partnership between the Miriam Hospital, the state corrections and health departments, Brown University Hospital, and numerous community-based providers of housing, substance abuse treatment, and related services. Project Bridge's infectious-disease specialists from Brown University and Miriam Hospital treat HIV-infected inmates throughout their incarceration and continue to treat offenders after their return to the community.

The greater the link between community providers and correctional facilities, the greater the likelihood that care will continue upon release and that investment in prison- and jail-based health care will pay off in public health dividends. In less comprehensive collaborations, community-based organizations often serve in a supportive or educational role (see Recommendation c, below, for more on relying on community-based organizations for health education).

Example: AIDS in Prison Project, Osborne Association (NY)

The AIDS in Prison Project provides HIV testing, counseling, and discharge planning on-site to New York prisoners at Sing Sing, Fishkill, Downstate and Green Haven Correctional Facilities. In addition, the organization sponsors a hotline for prisoners and their families that covers topics including information about HIV, AIDS, and hepatitis C, as well as prevention of infectious diseases, treatment, referrals, transitional planning, and advocacy.

Even non-physicians with proper training can provide limited clinical services and extensive advocacy and supportive services to supplement prison-based health care. Corrections administrators should seek to engage state departments of public health to develop and implement effective care models that consider both individual and community health. (See Policy Statement 35, Physical Health Care Systems)