By Jasmine L. Kiai and John D. Stobo

Gov. Arnold Schwarzenegger recently proposed in his State of the State address to limit the amount of state general funds given to the prison system (from 10 percent to 7 percent) and to direct these savings to higher education. He also proposed an amendment to the state constitution stipulating that state spending on higher education (University of California and California State University) would not go below 10 percent (it is currently 6-7 percent). This proposal is a good first step toward reinvesting in higher education. We agree with the governor’s statement that California should not be spending more money on prisons than it does on higher education.

Some have said that decreasing the budget for the California Department of Corrections and Rehabilitation must wait until the number of prisoners has been decreased. This is not entirely true. California is spending approximately $2 billion a year for prison health care and this is much higher than what is spent in other states. Savings in this portion of the prison budget could be addressed relatively quickly and applied to higher education without decreasing the prison population.

The cost of health care for each inmate per year in California is approximately $11,600, while the cost of prison healthcare in New York is $5,757; Florida, $4,720; Pennsylvania, $4,418; and Texas, $2,920. Why is it more expensive to provide health care to inmates in California than it is in other states? Are the inmates in California older or do they have more health problems than inmates in other states? The answer is no. There is no evidence that the inmates in California are older, sicker or have more costly conditions than inmates in other states. Furthermore, the Texas prison system has roughly the same number of inmates as California – approximately 170,000. Therefore, the difference in the cost of prison health care in California versus other states is explained by how health care is delivered.

It is possible for the California prison system to decrease cost and increase quality. Texas was able to spend less on health care and improve the quality of care by transforming the way health care was delivered within the prison system. For example, the prison system started implementing clinical protocols, an electronic medical records system, pharmacy management practices and telemedicine. The number of yearly telemedicine consultations in Texas is 80,000 while the number in California is approximately 16,000. Furthermore, the Texas prison system used other health care professionals (e.g., physician assistants, nurse practitioners) to treat inmates. This was a key factor in decreasing health care costs.

If California implemented a system similar to the one in Texas, the anticipated yearly savings could be approximately $1.5 billion. If the cost for prison health care in California approached that in New York, the savings could be approximately $993 million. These savings could then be invested in higher education (UC and CSU) where funds are desperately needed to continue providing high quality education to our students.

While UC’s role in prison health care remains to be determined, we feel we have a responsibility as a public trust to be an important part of the discussions of how prison health care in California can be improved. The governor’s commitment to use savings in the prison system to support higher education is another imperative supporting UC’s role in determining how health care is delivered in California state prisons.

Jasmine L. Kiai, J.D.
Health Policy and Project Analyst
UC Health Sciences and Services

John D. Stobo, M.D.
Senior Vice President
UC Health Sciences and Services