Abstract
BackgroundThe purpose of this study is to apply Andersen’s Behavioral Model of Health Service Use to men’s prisons to assess the direct and indirect effects of inmate predisposing characteristics through multiple types of need. Also examined are the effects of prison-specific enabling factors and the variation in use of health services across prisons. This study uses a nationally representative U.S. sample of men incarcerated in state prisons (n = 8816) and generalized structural equation and multilevel modeling. Five types of need—medical condition, illness, dental problem, unintentional injury, and intentional injury—are assessed for their association with use of health services.ResultsFindings indicate that a number of inmate predisposing (age, race, education) and vulnerability (mood/anxiety disorder,) characteristics are associated with use of health services but are partially mediated by enabling and need factors. Each type of medical need has strong direct effects with mood/anxiety disorder emerging as the strongest total effect (including both direct effects and indirect effects through need). There is significant variation in rates of health service utilization across prisons that is not accounted for by the prison-level factors included in the multilevel model.ConclusionsThe varying patterns of health service use across prisons suggest that incarceration may be an important circumstance that shapes health. In other words, where someone is incarcerated may influence their ability to access and use services in response to medical need. It is important that prisons provide integrated services for inmates with mood/anxiety disorder given high comorbidity with other health conditions.
Highlights
The purpose of this study is to apply Andersen’s Behavioral Model of Health Service Use to men’s prisons to assess the direct and indirect effects of inmate predisposing characteristics through multiple types of need
Data The 2004 Bureau of Justice Statistics (BJS) Survey of Inmates in State Correctional Facilities (SISCF) provides a nationally-representative sample of persons incarcerated in state prisons
Hours in work assignment had a minimal effect (OR = 1.00, p ≤ 0.05) while every year incarcerated contributed to 21% higher odds of using health services (OR = 1.21, p ≤ 0.001), but this effect lessens over time (OR = 0.99, p ≤ 0.001)
Summary
The purpose of this study is to apply Andersen’s Behavioral Model of Health Service Use to men’s prisons to assess the direct and indirect effects of inmate predisposing characteristics through multiple types of need. The Court ruled that prisoners are entitled to access to care for diagnosis and treatment, a professional medical judgment, and administration of the treatment prescribed by the physician. The Court ruled that: Deliberate indifference to serious medical needs of prisoners constitutes the “unnecessary and wanton infliction of pain”... This is true whether the indifference is manifested by prison doctors in their response to the prisoner’s needs or by prison guards intentionally denying or delaying access to medical care or intentionally interfering with
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