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Abstract

Objective: To investigate the effects co-payment policies in the correctional health environment on access and utilization of healthcare services, cost-effectiveness of care, and health outcomes. Methodology: A literature search yielded 97 articles, 15 duplicates were eliminated. Thirty-three additional articles not in peer review journals were eliminated; 40 were eliminated because they did not focus on the research question and four were eliminated because they did not adequately present their data. A decision was made to retain the four quantitative studies in the review, and to utilize the single qualitative study to support conclusions and, or the discussion section. The Reporting Guidelines for Survey Research were utilized to assess the quality of the studies. Results: Four surveys demonstrated that co-pays could reduce health services utilization. The impact upon the quality of care to inmates is unknown at this time. Conclusion: Given the paucity of literature on this subject and the two decades that co-pays have been used in the prison/jail systems, rigorously designed studies are needed to examine the effect upon quality of care. Significant ethical issues for this highly vulnerable population are concerning given the undue burden of unmet health needs that must be balanced with the public need for fiscal accountability.

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