Prison medicine, public health policy and ethics: the Geneva experience

Elger, Bernice Simone

doi:10.4414/smw.2011.13273

Cited by 19 publications

(13 citation statements)

References 28 publications

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“…In the Canton of Vaud, healthcare service provision inprison is independent of the judiciary authorities since 1995 [ 29 ]. Each prison has an on-site outpatient clinic managed by the Service of Correctional Medicine and Psychiatry (SMPP) of the University Hospital of Lausanne (CHUV).…”

Section: Methodsmentioning

confidence: 99%

Exploring differences in healthcare utilization of prisoners in the Canton of Vaud, Switzerland

et al. 2017

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Prison healthcare is an important public health concern given the increasing healthcare needs of a growing and aging prison population, which accumulates vulnerability factors and suffers from higher disease prevalence than the general population. This study identifies the key factors associated with outpatient general practitioner (GP), nursing or psychiatric healthcare utilization (HCU) within prisons. Cross-sectional data systematically collected by the prison medical staff were obtained for a sample of 1664 adult prisoners of the Canton of Vaud, Switzerland, for the year 2011. They contain detailed information on demographics (predisposing factors), diagnosed chronic somatic and psychiatric disorders (needs factors), as well as prison stay characteristics (contextual factors). For GP, nurse and psychiatric care, two-part regressions are used to model separately the probability and the volume of HCU. Predisposing factors are generally not associated with the probability to use healthcare services after controlling for needs factors. However, female inmates use higher volumes of care, and the volume of GP consultations increases with age. Chronic somatic and psychiatric conditions are the most important predictors of the probability of HCU, but associations with volumes differ in their magnitude and significance across disease groups. Infectious, musculoskeletal, nervous and circulatory diseases actively mobilize GP and nursing staff. Schizophrenia, illicit drug and pharmaceuticals abuse are strongly positively associated with psychiatric and nurse HCU. The occupancy rate displays positive associations among contextual factors. Prison healthcare systems face increasingly complex organizational, budgetary and ethical challenges. This study provides relevant insights into the HCU patterns of a marginalized and understudied population.

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Section: Methodsmentioning

confidence: 99%

Exploring differences in healthcare utilization of prisoners in the Canton of Vaud, Switzerland

et al. 2017

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“…However, the absolute number of incarcerated individuals increased by 25% between 2000 and 2014 [ 4 ]. As in most European countries, the principle of equivalence of care applies, meaning that all individuals in prison have the right to access the same standards of quality of health care as the general population [ 5 – 7 ]. Hence, prison systems are required to meet the health needs of individuals in prison with limited resources and while facing important organizational and ethical challenges.…”

Section: Introductionmentioning

confidence: 99%

The determinants of individual health care expenditures in prison: evidence from Switzerland

Moschetti

Zabrodina

Wangmo

et al. 2018

BMC Health Serv Res

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BackgroundPrison health systems are subject to increasing pressures given the specific health needs of a growing and aging prison population. Identifying the drivers of medical spending among incarcerated individuals is therefore key for health care governance in prisons. This study assesses the determinants of individual health care expenditures within the prisons of the canton of Vaud, a large region of Switzerland.MethodsWe use a unique dataset linking demographic and prison stay characteristics as well as objective measures of morbidity to detailed medical invoice data. We adopt a multivariate regression approach to model total, somatic and psychiatric outpatient health care expenditures.ResultsWe find that chronic infectious, musculoskeletal and skin diseases are strong predictors of total and somatic costs. Schizophrenia, neurotic and personality disorders as well as the abuse of illicit drugs and pharmaceuticals drive total and psychiatric costs. Furthermore, cumulating psychiatric and somatic comorbidities has an incremental effect on costs.ConclusionBy identifying the characteristics associated with health care expenditures in prison, this study constitutes a key step towards a more efficient use of medical resources in prison.

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“…Prisoners are deprived of their freedom but retain their right to health (Elger, 2008;Elger, 2011;Lines, 2008). Prisoners are deprived of their freedom but retain their right to health (Elger, 2008;Elger, 2011;Lines, 2008).…”

Section: Introductionmentioning

confidence: 99%