Access to Mental Health Services among Released State Prisoners

获释国家囚犯获得心理健康服务的机会

基本信息

批准号：
8583841
负责人：
DAVID L ROSEN
金额：
$ 22.8万
依托单位：
UNIV OF NORTH CAROLINA CHAPEL HILL
依托单位国家：
美国
项目类别：
财政年份：
2013
资助国家：
美国
起止时间：
2013-09-01 至 2015-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8583841
关键词：
Address Admission activity Advocate Affect Aftercare Back Caring Chronic Chronically Ill Communities Community Health Continuity of Patient Care Criminal Justice Data Data Set Databases Disabled Persons Disease Eligibility Determination Enrollment Event Funding Future General Population Goals HIV HIV Infections Health Health Care Costs Health Services Health Services Accessibility Healthcare Hospitalization Human Resources Imprisonment Individual Laws Lead Length Link Medicaid Mental Health Mental Health Services Mind New York North Carolina Pattern Persons Pilot Projects Policies Population Prevalence Prisoner Prisons Public Health Records Research Resources Services Societies Suspension substance Suspensions Symptoms System Therapeutic Time Ursidae Family beneficiary burden of illness community living community setting comparative effectiveness cost disease transmission evidence base health care service utilization health economics improved interest novel programs public health relevance routine care severe mental illness social

项目摘要

DESCRIPTION (provided by applicant): Incarcerated persons bear a heavy burden of chronic and severe health conditions: the prevalence of HIV among prisoners is five times that of the general population, and 25%-50% of prisoners have a mental health condition. Before incarceration, some of the most disabled and impoverished prisoners, including those with severe mental illness, are able to access healthcare through enrollment in Medicaid. Little is known about the exact healthcare needs of these individuals, but their eligibility for Medicaid and involvement with the criminal justice system suggest a maelstrom of social, economic, and health-related problems. The continued access to healthcare as these individuals transition to their community is particularly important to protect their own health and the health of the communities to which they return. Yet current policies in much of the US impede resumption of Medicaid at prison release. In most states, Medicaid enrollment is terminated upon admission to prison; prisoners may re-apply for Medicaid following their release from prison, but approval often takes months. Until they resume Medicaid coverage, recently released chronically ill prisoners must navigate the difficult transition back to community life typically with no means to pay for health services. The effects of these lapses in Medicaid are not well understood, but existing evidence suggests that for released prisoners with chronic and severe disorders, gaps in care lead to worsened health, disease transmission, re-incarceration, and higher healthcare costs. To diminish gaps in care, New York in 2008 began suspending, rather than terminating, Medicaid benefits upon imprisonment, allowing released prisoners to immediately resume Medicaid coverage. Although it is assumed that Medicaid suspension-compared to termination-improves continuity of care, the actual effect of this policy is unknown. To assess the effect of Medicaid policy on former prisoners' use of healthcare, we will construct and analyze a novel database linking state prison records with Medicaid records. We will link records for the years 2007-2009 for New York (NY) and North Carolina (NC). Comparing data from before and after the policy change in NY, we will examine whether Medicaid policy (termination vs. suspension) had an effect on how quickly released prisoners who were enrolled in Medicaid prior to their incarceration resumed Medicaid-funded services after their release. Using data from NY and NC, we will also examine whether gaps in resuming Medicaid-funded care affects the amount of Medicaid-funded care used (e.g. hospitalization days), the costs of that care, and re-incarcerations. In addition to the proposed analyses, the database constructed in this pilot project will lead to several future lines of policy-significant research to improve the health and mental health of released prisoners.

描述（由申请人提供）：被监禁的人承担着慢性和严重健康状况的沉重负担：囚犯中艾滋病毒的患病率是普通人群的五倍，而25％-50％的囚犯患有精神健康状况。在监禁之前，一些最残疾和贫困的囚犯（包括患有严重精神疾病的囚犯）能够通过入学医疗补助来获得医疗保健。这些人的确切医疗保健需求知之甚少，但是他们有资格获得医疗补助和参与刑事司法系统的资格表明，社会，经济和健康有关的问题漩涡。由于这些人向社区过渡，继续获得医疗保健，这对于保护自己的健康和返回社区的健康特别重要。然而，美国大部分地区目前的政策阻碍了监狱释放时的医疗补助。在大多数州，医疗补助入学率在入狱后被终止；囚犯从监狱释放后可能会重新申请医疗补助，但批准通常需要几个月的时间。在他们恢复医疗补助覆盖范围之前，最近释放的长期生病的囚犯必须在艰难的过渡到社区生活中，通常无法支付卫生服务费用。这些失误在医疗补助中的影响尚不清楚，但现有的证据表明，对于患有慢性和严重疾病的释放囚犯，护理差距会导致健康状况恶化，疾病传播，重新监禁和更高的医疗保健费用。为了减少护理差距，纽约于2008年开始暂停监禁而不是终止医疗补助福利，从而允许释放的囚犯立即恢复医疗补助的承保范围。尽管假定医疗补助暂停对终止的护理连续性，但本政策的实际效果尚不清楚。为了评估医疗补助政策对前囚犯使用医疗保健的影响，我们将构建和分析一个新颖的数据库，该数据库将州监狱记录与医疗补助记录联系起来。我们将链接纽约（NY）和北卡罗来纳州（NC）的2007 - 2009年度记录。比较纽约政策发生变更政策之前和之后的数据，我们将检查医疗补助政策（终止与暂停）是否会影响释放在被监禁之前入学的囚犯的迅速释放后，他们释放了医疗补助后资助的服务。使用纽约和NC的数据，我们还将检查恢复医疗补助资助的护理中的差距是否会影响使用的医疗补助护理量（例如住院日），该护理的成本和重新监禁。除了提议的分析外，该试点项目中构建的数据库还将导致未来的政策重要研究，以改善已释放的囚犯的健康和心理健康。