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Increased Hospital and Emergency Department Utilization by Individuals with Recent Criminal Justice Involvement: Results of a National Survey

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ABSTRACT

BACKGROUND

Individuals involved with the criminal justice system have increased health needs and poor access to primary care.

OBJECTIVE

To examine hospital and emergency department (ED) utilization and related costs by individuals with recent criminal justice involvement.

DESIGN

Cross-sectional survey.

PARTICIPANTS

Non-institutionalized, civilian U.S. adult participants (n = 154,356) of the National Survey on Drug Use and Health (2008–2011).

MAIN MEASURES

Estimated proportion of adults who reported past year 1) hospitalization or 2) ED utilization according to past year criminal justice involvement, defined as 1) parole or probation, 2) arrest without subsequent correctional supervision, or 3) no criminal justice involvement; estimated annual expenditures using unlinked data from the Medical Expenditure Panel Survey.

KEY RESULTS

An estimated 5.7 million adults reported parole or probation and an additional 3.9 million adults reported an arrest in the past year. Adults with recent parole or probation and those with a recent arrest, compared with the general population, had higher rates of hospitalization (12.3 %, 14.3 %, 10.5 %; P < 0.001) and higher rates of ED utilization (39.3 %, 47.2 %, 26.9 %; P < 0.001). Recent parole or probation was an independent predictor of hospitalization (adjusted odds ratio [AOR], 1.21; 95 % confidence interval [CI], 1.02–1.44) and ED utilization (AOR, 1.35; 95 % CI, 1.12–1.63); Recent arrest was an independent predictor of hospitalization (AOR, 1.26; 95 % CI, 1.08–1.47) and ED utilization (AOR, 1.81; 95 % CI, 1.53–2.15). Individuals with recent criminal justice involvement make up 4.2 % of the U.S. adult population, yet account for an estimated 7.2 % of hospital expenditures and 8.5 % of ED expenditures.

CONCLUSIONS

Recent criminal justice involvement is associated with increased hospital and ED utilization and costs. The criminal justice system may offer an important point of contact for efforts to improve the healthcare utilization patterns of a large and vulnerable population.

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Funders

Dr. Frank was supported by the Health Resources and Services Administration through an institutional National Research Service Award (T32 HP10251). Dr. Becker is supported by a Veterans Health Administration Health Services Research & Development Career Development Award (08-276). Dr. Wang is supported by the National Heart, Lung and Blood Institute (K23 HL103720).

Prior Presentations

We presented a preliminary version of these findings at the Academic and Health Policy Conference on Correctional Health on 22 March 2013 in Chicago, IL, and at the Society of General Internal Medicine Meeting on 26 April 2013 in Denver, CO.

Conflict of Interest

The authors declare that they do not have a conflict of interest.

Author information

Authors and Affiliations

  1. Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO, USA

    Joseph W. Frank MD, MPH

  2. Denver VA Medical Center, Denver, CO, USA

    Joseph W. Frank MD, MPH

  3. Division of General Medicine and Primary Care, Brigham and Women’s Hospital, Boston, MA, USA

    Jeffrey A. Linder MD, MPH

  4. Harvard Medical School, Boston, MA, USA

    Jeffrey A. Linder MD, MPH

  5. VA Connecticut Healthcare System, West Haven, CT, USA

    William C. Becker MD

  6. Section of General Internal Medicine, Yale University School of Medicine, New Haven, CT, USA

    William C. Becker MD, David A. Fiellin MD & Emily A. Wang MD, MAS

Authors
  1. Joseph W. Frank MD, MPH
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  2. Jeffrey A. Linder MD, MPH
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  3. William C. Becker MD
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  4. David A. Fiellin MD
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  5. Emily A. Wang MD, MAS
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Corresponding author

Correspondence to Joseph W. Frank MD, MPH.

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Frank, J.W., Linder, J.A., Becker, W.C. et al. Increased Hospital and Emergency Department Utilization by Individuals with Recent Criminal Justice Involvement: Results of a National Survey. J GEN INTERN MED 29, 1226–1233 (2014). https://doi.org/10.1007/s11606-014-2877-y

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  • DOI: https://doi.org/10.1007/s11606-014-2877-y

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