Pew: State Prison Health Care Spending Trending Down Since Peak

Pew: State Prison Health Care Spending Trending Down Since Peak

WASHINGTON—State spending on prisoner health care increased from fiscal years 2007 to 2011, but it is trending downward from its peak in 2009, according to a new report from the State Health Care Spending Project, an initiative of The Pew Charitable Trusts and the John D. and Catherine T. MacArthur Foundation. The report, State Prison Health Care Spending: An Examination, analyzes four key factors driving prison health care costs and outlines strategies states are using to manage costs while preserving health care quality for incarcerated offenders.

The project found that correctional health care spending rose in 41 states from 2007 to 2011, with median growth of 13 percent. Spending on a per-inmate basis also rose in most states during that time, with median growth of 10 percent. In a majority of states, however, total spending and per-inmate health care spending peaked before 2011. Nationwide, prison health care spending totaled $7.7 billion in 2011, down from a peak of $8.2 billion in 2009, after adjusting for inflation. The downturn in spending was due in part to a reduction in state prison populations. 

The report also examined the portion of inmates 55 and older, who typically require more expensive care than younger inmates. From 2007 to 2011, the share of older inmates rose in all but two of the 42 states that submitted data. Not surprisingly, states where older inmates represented a relatively large share of the population tended to have higher per-inmate spending.

“While spending began trending down from its peak in 2009, prison health care continues to pose a fiscal challenge for states,” said Maria Schiff, director of the State Health Care Spending Project. “Understanding what is driving their state’s unique health care expenses will help policymakers manage their systems more efficiently and evaluate ways to contain costs more effectively.”

Several characteristics of state corrections systems can affect delivery of health care and increase costs. These include:

  • Prison population trends. The growth or decline in state correctional health care spending reflects changes in the size of prison populations.
  • Older inmates, greater expense. There is evidence of a relationship between the relative size of a state’s older inmate population and per-inmate spending.
  • Prevalence of disease and mental illness. Inmates have a higher incidence of mental illness and chronic and infectious diseases than the general public. These conditions are costly to treat and place a burden on state correctional budgets.
  • Location and inmate transportation. States with prisons far from population centers face increased expenses for guarding, transporting, and housing inmates who travel long distances for care.

The report explores four strategies states are using to manage costs while preserving health care quality for inmates: use of telehealth technologies, outsourcing of prison health care, enrollment of prisoners in Medicaid, and appropriately paroling older and/or ill inmates.  

Collection of spending data for this report was completed in partnership with the Vera Institute of Justice. Data on the share of older inmates was collected from a survey conducted with the Association of State Correctional Administrators. This analysis builds on previous work by the State Health Care Spending Project, including a 2013 report, which found that correctional health care spending rose in 42 of 44 states surveyed from 2001 to 2008. The report is part of a series examining seven key areas of state health care spending, including prison health care, which will provide a comprehensive examination of state-funded health programs. 

In addition to conducting research on prison health care spending, Pew also works with states to advance data-driven, fiscally sound policies and practices in the criminal and juvenile justice systems that protect public safety, hold offenders accountable, and control corrections costs. A recent report, Max Out: The Rise in Prison Inmates Released Without Supervision, found that more than 1 in 5 state inmates maxed out their prison terms and were released to their communities without any supervision in 2012, undermining efforts to reduce reoffending rates and improve public safety. The report outlines a policy framework to guide state leaders in reducing max-outs and recidivism. 


The Pew Charitable Trusts is driven by the power of knowledge to solve today’s most challenging problems. Learn more at

The John D. and Catherine T. MacArthur Foundation supports creative people and effective institutions committed to building a more just, verdant, and peaceful world. Learn more at

States of Innovation