Provision of Medical Care in Local County and City Jails: A comparison of healthcare delivery in Virginia and West Virginia Public Deposited

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  • February 28, 2019
  • McDonnell, Holly
    • Affiliation: Gillings School of Global Public Health, Department of Health Policy and Management
  • This report aims to inform policy makers, public health officials and jail administrators about how healthcare is structured, delivered and financed in local county and city jail facilities. Specifically, how medical care is provided in local jail facilities in Virginia and West Virginia. This is an area where limited academic research has been conducted, making it difficult for policy makers and jail administrators to understand how healthcare should be best provided to inmates. Every year millions of Americans cycle through our local jail systems. In 2016 alone, there were over 10.6 million admissions to jails (Zeng, 2018). Most of these stays are temporary with jails turning over roughly half of their inmate population weekly (Zeng, 2018). This presents unique challenges for local jail administrators as they work towards ensuring their core mission of protecting the safety of the public and the secure confinement of individuals under their jurisdiction (“Federal Bureau of Prisons,” n.d.) and (Blakley, 2010). Under the 8th amendment inmates have a constitutional right to healthcare and jail administrators are compelled to provide adequate care to all inmates under their jurisdiction (“The Origin of Prisoner's Rights,” 2016). Making this operational for a constantly shifting population is a challenge, especially when considering that jail inmates are often in poorer health than the general population (Marks, 2014). For this report, I reviewed the academic and grey literature in this area, compared how healthcare is delivered in Virginia and West Virginia (adjacent states with contrasting jail facility organization and publicly available jail healthcare data), evaluated medical cost data and reviewed private medical vendor contracts and RFPs to determine how care is currently delivered in these states.Private medical vendors can present a way for jail administrators to reduce healthcare delivery challenges, guarantee care and mitigate risk for both budgetary concerns and delivery of care concerns. They provide known healthcare costs allowing for more predictable budgeting, expand access to care with 24/7 healthcare coverage and provide access to additional service lines. In response to services offered by vendors, local governments are becoming more sophisticated in their RFPs. More recent RFPs included request for chronic care management programs, non-proprietary EMR systems, increased mental healthcare and behavioral health staff requirements, reimbursement for care from individual’s personal healthcare insurance, compliance with new regulations and risk sharing payment options with vendors. Additional research is needed in this area, especially in areas such as healthcare delivery structure, cost and quality of care. Jail facilities, governments and healthcare providers should share information and data to advance delivery of care across the system. A more centralized or regional jail system may help to decrease cost variability in the future. Local governments should continue to enhance their RFPs and medical vendor contracts to increase service lines, provide better care to inmates and decrease their administrative burden.
Date of publication
Resource type
Rights statement
  • In Copyright
  • Domino, Marisa
  • Master of Science in Public Health
Academic concentration
  • Health Policy Management
Degree granting institution
  • University of North Carolina at Chapel Hill
Graduation year
  • 2018
Deposit record
  • 32d8eec1-7c52-4817-8573-9e65bc0e3ac1

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