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There are an estimated two million individuals incarcerated in the prisons and jails that sprawl the United States, a staggering percentage of this population would be found in the Texas Department of Criminal Justice (TDCJ) or in short the Texas State prisons system (Charuvastra et al., 2001).

The Texas prisons system houses one of the largest collection of prisons and other correctional facility in the United States, with one out every ninth US prison inmate in Texas prisons. Together with California, the Texas prisons is believed to house about one third of all US prison inmates (Baillargeon et al., 2000).

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Presenting facts to back up this contention, Raimer and Stobo (2004) state that as at 2002, 145 000 adults were incarcerated in more than 100 facilities under the jurisdiction of the Texas Department of Criminal Justice (TDCJ). In addition to this number, another 11,000 offenders were housed in about seven correctional facilities under private control. Based on this fact, the authors contend that the Texas Department of Criminal Justice, perhaps, makes up one of the largest collection of correctional facilities in the western world.

With respect to healthcare and medical attention, all inmates of the Texas Prisons system are required to have medical attention at the time of incarceration. The medical evaluation carried out on new entrants usually consists of a detailed medical history, a comprehensive physical examination, and a number of diagnostic procedures (Baillargeon et al., 2000).

Considering the staggering population of the Texas Prisons, and more importantly, the continuously increasing population of individuals in the prison system, healthcare cost becomes a worrisome subject. While Combs (1999) reports that the Texas prison population increased from 49,000 in 1990 to a staggering 143,000 in 1998, a 192% increase in less than a decade, Baillargeon and others, however put the Texas prison population at 179,000. Of a fact, providing healthcare to this burgeoning is obviously an uneasy and expensive task.

Therefore, the purpose of this essay is to examine the Texas Prison System healthcare system and to report on the cost incurred in providing healthcare to the inmates of the numerous correctional facilities that make up the Texas Prison systems.

To achieve this purpose, the remaining part of the essay will be structured thus: the next section of the essay will take a general overview of the Texas Prison Healthcare system and how it functions.

This will be followed by a look at some of the several prevalent diseases in the prison system that constitutes the bulk of conditions requiring treatment. The fourth section of this essay will then look at the costs of these medical interventions and how or what the Texas state has done to cost and improve on correctional healthcare delivery. This will then be followed by a conclusion.

Texas Prisons Healthcare System

Raimer and Stobo (2004) gave a good account of the Texas Prisons healthcare system. Prior to the 1970s, the prisons healthcare system relied on small infirmary in each facility, while the Huntsville Unit Hospital served as the primary medical facility for inmates.

Also, inmates requiring specialty care were referred to John Sealy Hospital at the University of Texas Medical Branch (UTMB) in Galveston. Besides the fact that this system was largely fragmented, the swelling population of the prison system and repeated calls from several corners for improvement of correctional healthcare led to an overhaul of the Texas Prisons Healthcare System.

This move first began with the replacement of the aging John Sealy Hospital with a new 8-storey structure at UTMB in 1983; which became the first prison hospital to be located on an academic medical center campus.

However, with the intention to further improve the healthcare delivery for prison inmates, while at the same time reducing the soaring cost of medical treatment and other health care needs for prison inmates, the Texas Department of Criminal Justice (TDCJ) established the Correctional Managed Health Care Committee (CMHCC) in 1993, which was charged with the responsibility of developing a healthcare delivery plan based on a managed care network of clinicians and facilities. And in 1994, the Texas Department of Criminal Justice (TDCJ) became the first to implement a correctional managed health care program (Raimer and Stobo, 2004; Combs, 1999).

The present Texas Prisons Healthcare System, according to Raimer and Stobo (2004) is based on a series of contractual relationships between TDCJ, CMHCC, and 2 state medical schools – the University of Texas Medical Branch (UTMB) and Texas Tech University Health Sciences Center (TTUHSC).

The arrangement under this contractual agreement works like this: the Texas Department of Criminal Justice (TDCJ) contracts with Correctional Managed Health Care Committee (CMHCC) to provide and coordinate correctional health services across the state, the CMHCC in turn contracts with the two state medical schools, UTMB and TTUHSC to provide medical, dental, and psychiatric care to the prison population and the whole program is funded by an annual appropriation from the State Legislature to TDCJ..

While the UTMB which serves about 78% of the Texas prison population uses mostly its employees to meet the healthcare needs of the prison population, TTUHSC which serves about 22% of the Texas prison population – essentially the western portion of Texas makes use of a mix of its employees and subcontracted local clinicians, as need be, to meet this responsibility.

Furthermore, the present state of the healthcare structure of the Texas Prison system comprises of ambulatory clinics in every correctional facility, which is charged with primary care; basic dental and mental health services at selected clinics, chronic care clinics at selected location and an additional infirmaries with capacities ranging from 7 to 116 beds in 16 correctional facilities.

However, more advanced healthcare needs are referred to the Hospital Galveston and several other regional medical facilities. With such expansive healthcare system, Texas could be well said to be adequately catering for the healthcare needs of its prison inmates, though Baillargeon and others (2000) suggest otherwise and cost is one important factor that has been cited as the restraining influence on adequate correctional healthcare delivery system.

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