Prisons which implement telemedicine systems instead of the conventional in-prison care could save about $102 per patient encounter. This was stated in a report by the American National Institute of Justice (NIJ), that was issued in March 1999 under the title Telemedicine can reduce correctional health care costs: an evaluation of a prison telemedicine network. The study has been conducted during the period between September 1996 and December 1997. Four federal prisons were involved in the research. The major objective of the project was to test the feasibility of remote telemedical consultations in prisons as well as to assess the financial impacts of implementing telemedicine in other prison systems.
The National Institute of Justice, which is the research branch of the Department of Justice, contracted Abt Associates Company to assess the demonstration and evaluate the relation between the expenses and savings, related to the implementation of a leased telemedicine network in the four selected prisons. One network suite was used for inmates at both the United States Penitentiary and the Federal Correctional Institution in Allenwood, Pennsylvania; a second served prisoners at the United States Penitentiary in Lewisburg, Pennsylvania; and a third delivered care to people at the Federal Medical Center, a prison health care facility in Lexington, Kentucky. All three sites were networked for telemedicine with the Department of Veterans Affairs Medical Center, also located in Lexington.
The Veterans Affairs and Federal Medical Centers in Lexington were used as the hubs in this network. Specialist physicians and other health care experts were called upon to participate in the remote consultations with prisoners in the three Pennsylvania prisons. As in the majority of the federal prisons, the traditional way of delivering medical care in the Pennsylvania prisons can be performed in four different ways. Whether through routine care provided by prison employees; or via in-person clinics contracted by prisons; or in clinics requiring transportation outside the prison facility; or extensive care which necessitates transportation by plane to one of the Bureau of Prisons' Federal Medical Centers. Telemedicine has been added as a fifth option to try and solve the specific problems that are associated with the other four methods, such as for instance transportation outside the facility.
Next to the tackling of security issues by avoiding air or car travels with the prisoners outside the walls of the facility, the telemedicine project also was utilized as a means to measure costs and use of equipment in order to define in which prisons telemedicine implementation would be the right decision to address the inmates' health care problems. The report supplies cost figures, indicating that a telemedicine consultation would be $71, compared to $173 for conventional care. Abt Associates staff analysed data extracted from BOP management information and accounting systems, data which were collected by telemedicine site coordinators, additional cost data made by the Bureau as well as by Tracor Systems Technologies Inc., which was the telemedicine prime contractor, and anecdotal data derived from interviews with the health services administrators and clinicians involved in the project.
The results show that telemedicine constitutes a quickly adopted method to be frequently used in different medical specialities. During the project, a total of 1321 tele-consultations were performed. Remote consultations were especially effective as an excellent substitute for in-person examinations in psychiatry and dermatology, but far less efficient for the areas of cardiology and orthopaedics. Telemedicine was able to cancel approximately 35 trips to local specialists. However, since most of the trips to local physicians involve invasive tests and procedures or specialized equipment which are impossible to introduce into the prison, tele-consultations constituted rather inadequate substitutes for this kind of travels. About 13 to 14 transfers by air charter to a Federal Medical Center for psychiatric care could be avoided by the use of telemedicine.
The project's financial results based on a leased telemedicine system served as a starting point to assess the costs for installation of a purchased system. It was found that the use of telemedicine is cheaper than conventional BOP practice. As such, in an operational telemedicine system developed in this way, the savings earned in approximately 1544 encounters would equal the purchase cost of the telemedicine equipment. The project yielded some 100 encounters per month. Thus, the initial equipment costs might be recovered in about 15 months, with monthly savings of $14.200 afterwards. In prisons where the number of air transfers and trips out is lower, the average cost of telemedicine would correspond to conventional, in-prison consultations.
As for the quality of care in the demonstration, less time went by between a prisoner's referral to a specialist and the actual consultation, due to the fact that the experts were more frequently accessible by telemedicine, which also goes for the specialities who were not locally available. Even in those areas where local specialists delivered care, telemedicine offered access to doctors with more experience in the treatment of prisoners. Telemedicine seems also to lead to more quiet prisons with less incidents of violence because of the optimized psychiatric care but this is still a mere hypothesis. In any case the report proves that savings are most likely to result if frequent, individual transfers via air charter are cancelled and when in-prison examinations are substituted by telemedicine consultations. The full report is available at the Web site of the US National Institute of Justice.