Healthcare Utilization by Individuals with Criminal Justice Involvement: Results of a National Survey
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1 Healthcare Utilization by Individuals with Criminal Justice Involvement: Results of a National Survey Frank JW, Linder JA, Becker WC, Fiellin DA, Wang EA
2 Background U.S. criminal justice population is large & growing High burden of disease & mortality yet access to care is poor No national estimates of acute care utilization & costs exist
3 Background U.S. criminal justice population is large & growing High burden of disease & mortality yet access to care is poor No national estimates of acute care utilization & costs exist
4 Background U.S. criminal justice population is large & growing High burden of disease & mortality yet access to care is poor No national estimates of acute care utilization & costs exist
5 Study Aims Primary Aim To describe utilization of hospital and emergency department (ED) services by individuals with recent criminal justice involvement Secondary Aim To estimate expenditures associated with utilization of hospital and ED services
6 Data Sources National Survey on Drug Use and Health, Annual survey of U.S. civilian population Assesses prevalence and incidence of illicit drug, alcohol & tobacco use Medical Expenditure Panel Survey, Nationally representative estimates of expenditures for U.S. civilian population
7 Independent variable Self-reported past year criminal justice involvement 1. Parole or probation 2. Arrest only 3. None
8 Dependent variables Self-reported past year hospitalization Dichotomous (None vs. Any) Total hospital days Self-reported past year ED visit Dichotomous (None vs. Any) Total ED visits
9 Covariates Sociodemographic Age Gender Race/ethnicity Insurance Education Employment Income Marital status Rural/urban Year Clinical General health status Serious psychological distress Diagnoses Psychiatric Medical Substance use
10 Analysis Χ 2 test for differences in weighted estimates Multivariable logistic regression to identify independent effect of criminal justice involvement Expenditure estimates via MEPSNet Query Tool Hospital day & ED visit Adjusted for age, gender and survey year SAS 9.3 procedures to account for complex survey design
11 Sample Characteristics Unweighted sample Weighted estimate Parole/ Probation Arrest Only None , mill (2.6%) 3.9 mill (1.8%) 219 mill (96%) Individuals with criminal justice involvement were more likely to: Be young, male, black/hispanic, poor, uninsured or publicly insured Report mental health or substance use diagnoses
12 Aim #1: Association between criminal justice involvement & healthcare utilization
13 Healthcare Utilization 50 P=<.0001 Proportion Reporting Any Past Year Utilization (%) P=<.0001 Parole/Probation Arrest Only No Criminal Justice Involvement 0 Hospitalization ED Visit
14 Healthcare Utilization Adj. Odds Ratio (95% CI) Hospitalization Parole/Probation 1.33 ( ) Arrest Only 1.51 ( ) ED Visit Parole/Probation 1.25 ( ) Arrest Only 1.68 ( ) Referent group = No past year criminal justice involvement
15 Aim #2: Estimation of hospital & ED expenditures
16 Estimated Expenditures 3500 Mean Annual Per Capita Expenditures ($) Parole/Probation Arrest Only No Criminal Justice Involvement 0 Hospital Emergency Dept.
17 Limitations Self-reported data Excluded populations Absence of detailed clinical & correctional data MEPS expenditure data not linked to NSDUH data
18 Conclusions Criminal justice involvement associated with increased hospital & ED utilization Arrest without supervision è Highest risk of acute care utilization Increased utilization may translate into greater healthcare expenditures
19 Implications Novel high utilizer population Arrest, supervision & risk Cost data & investment in re-entry services
20 Thank You!
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22 Sample Characteristics Parole/Probation (N=6212) Arrest Only (N=4586) No Crim. Justice Involvement (N=143,558) Weighted Estimate Weighted Estimate Weighted Estimate Total 5.7 mill (2.6%) 3.9 mill (1.8%) 219 mill (96%) Age (years) % 59% 29% % 41% 71% Male sex 72% 74% 47% Race/Ethnicity* Insurance* White 57% 56% 69% Black 19% 23% 11% Hispanic 20% 17% 14% Private, Other 40% 41% 72% Medicaid/Medicare 20% 23% 13% Uninsured 40% 36% 15% P<.001 for all comparisons *P<.05 in pairwise comparison (Parole/Probation vs. Arrest Only)
23 Sample Characteristics Parole/Probation (N=6212) Arrest Only (N=4586) No Crim. Justice Involvement (N=143,558) Weighted Estimate Weighted Estimate Weighted Estimate Serious psychological 24% 23% 10% distress Substance Use Diagnoses Alcohol* 27% 34% 6% Prescription drug 5% 6% 1% Marijuana* 8% 11% 1% Other illicit drug 6% 6% 0.4% Tobacco dependence 42% 38% 13% P<.001 for all comparisons *P<.05 in pairwise comparison (Parole/Probation vs. Arrest Only) Prescription drug = Pain reliever, stimulant, sedative, tranquilizer
24 Healthcare Utilization P=<.0001 Proportion Reporting Any Past Year Utilization (%) P=<.0001 P=.76 P=.42 Parole Probation Arrest Only No Criminal Justice Involvement 0 Hospitalization ED Visit
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27 Total Past Year Encounters 9 Among Adults with 1+ Encounters Mean Encounters Per Capita Parole/Probation Arrest Only No Criminal Justice Involvement 0 Hospital Days ED Visits
28 A Disproportionate Share 9 8 Proportion of Total (%) U.S Adult Population Annual Hospital Expenditures Annual ED Expenditures
29 Expenditure Estimates Past Year Hospitalization Mean Nights (95% CI) Mean Expenditures (95% CI) Parole/Probation 0.8 ( ) $1995 ($ ) Arrest Only 1.0 ( ) $2378 ($ ) % Total Expenditures 7.2% ($20.5B) No Involvement.5 ( ) $1209 ($ ) 92.8% Past Year ED Visit Mean Visits (95% CI) Mean Expenditures (95% CI) Parole/Probation 1.0 ( ) $969 ($ ) Arrest Only 1.3 ( ) $1251 ($ ) % Total Expenditures 8.5% ($10.3B) No Involvement.52 ( ) $506 ($ ) 91.5%
30 Parole & Probation in the US
31 Past Year Criminal Justice Involvement Past Year Parole 72% also report probation 38% also report arrest Parole Est mill. Past Year Arrest 37% also report probation or parole Probation Est mill. Arrest Est mill. Past Year Probation 23% also report parole 43% also report arrest
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