Santa Clara County Grand Jury Report Raises Concerns About Inmate Health Care Costs
Santa Clara County should perform "a quantitative, business justification for the county adult inmate health care budget," according to a civil grand jury report filed on Monday, the San Jose Mercury News reports. The county annually spends $16.4 million more to provide health care services to 4,200 jail inmates than it spends to provide health care benefits for the same number of county employees.
According to the 44-page report -- titled, "Does Santa Clara County Pay Too Much for Adult Inmate Health Care?" -- the county each year spends about $9,100 per inmate, $3,900 more than its annual per-employee health care costs. During the last decade, the annual inmate health care budget has increased while the average daily inmate population has remained constant, the report found.
Bob Sillen, executive director of the Santa Clara Valley Health and Hospital System, said that about 65,000 inmates are held in county jails annually, on average for 100 days. The average daily inmate population is 4,200.
The report stated that the county's jail management structure provides "no clear incentives" to reduce health care costs because the county Department of Corrections administers the jails and has budgetary responsibility for health care services, which SCVHHS provides.
In addition, the grand jury stated that the current manual paper record-keeping system impedes health care delivery and cost management. The county late last year solicited bids for an electronic record-management system.
"The grand jury has serious concerns about the justification for the current level of adult inmate health care costs in the county," the report stated, calling the costs "high by a number of measures."
In the report, the grand jury stated that it was "hard-pressed to justify how such expenditures are warranted based on the identified differences between the population of inmates and that of county employees."
The report also recommended that the county:
- Consider adopting an inmate copayment system to reduce unnecessary inmate medical calls;
- Evaluate alternatives for offering care outside of county jails for the indigent and people with mental illnesses or substance abuse problems;
- Consolidate oversight of jail management and health care so employees report to the same county officials; and
- Implement an electronic records system.
Sillen said comparisons between health care costs for county employees and inmates are not accurate in part because inmates have higher incidence rates of alcohol and drug abuse, infectious diseases and mental illnesses than county employees.
"The costs per se are significant. But there's nothing we are aware of that is excessive in terms of the costs," Sillen said, adding that his department is preparing a detailed response to the report for the board of supervisors.
An April 2004 county-commissioned study by San Francisco consultants HOK Advance Strategies made similar recommendations, according to the Mercury News (Woolfolk, San Jose Mercury News, 5/19).