Hunter, Rachael;
(2024)
The Economics of Health Care in Prisons.
Doctoral thesis (Ph.D), UCL (University College London).
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Abstract
People in prison experience poorer health than their peers in the community (Seena Fazel & Baillargeon, 2011). Access to health care in prisons though can be challenging. The nature of the prison environment, where it is the responsibility of the prison to facilitate access to health care, but also to restrict a person’s movement, means that there are fewer supply and demand signals. It is the role of decision makers then to guide health care access in prisons, with the need to balance the right to health care for people in prison and the high cost and inefficiencies in delivering health care to this complex group. One method to quantify this is economic evaluations. The aim of this thesis is to define the characteristics of health and the health care market as they relate to prisons and the implications of these characteristics for evaluating the efficiency of delivering health care in prisons. This is achieved through identifying the aims and objectives of health care and prison, and identifying areas of market failure. An analysis of community mental health funding and the number of people sentenced to prison further explores market failure related to prisons. Data from Engager, a randomised controlled trial of an intervention for common mental health problems in prisons, is used for a trial based economic evaluation, the methods for which were informed by a systematic review of economic evaluations in prisons, an analysis to determine the key predictors of cost in prison and an analysis of the reliability and validity of preference based measures. This thesis finds that health care interventions related to mental health and prisons are likely to be inefficient. Governments need to prioritise addressing the social determinants of health to reduce the risk of intermediate outcomes such as poor mental health and substance misuse.
| Type: | Thesis (Doctoral) |
|---|---|
| Qualification: | Ph.D |
| Title: | The Economics of Health Care in Prisons |
| Open access status: | An open access version is available from UCL Discovery |
| Language: | English |
| Additional information: | Copyright © The Author 2023. Original content in this thesis is licensed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0) Licence (https://creativecommons.org/licenses/by-nc/4.0/). Any third-party copyright material present remains the property of its respective owner(s) and is licensed under its existing terms. Access may initially be restricted at the author’s request. |
| UCL classification: | UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Epidemiology and Health UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Epidemiology and Health > Primary Care and Population Health UCL |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10192467 |
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