Inequality, injustice… inaction? Prisoners' use of hospital services compared to the general population

Prisoners have a right to the same standards of health care available to people in the community, and although we might suspect that people in prisons don't always receive the care they need, this is a difficult issue to get at through research. So how can we meaningfully compare hospital use between those in prison and those who are not? In this chart of the week Miranda Davies and Eilís Keeble used a novel matched control methodology to show that prisoners use services less than people with similar health characteristics who are not incarcerated.

Chart of the week

Published: 11/12/2023

Health care for people in prison should be 'equivalent' to the care people receive in the general population. But what does this really mean? How can we meaningfully compare prisoners’ use of hospital services to what happens to people who are not in prison?

Many people enter prison in poor health, and prisoners often face challenges accessing health care while in prison, which makes direct comparison difficult. Using a novel research methodology we have created an approach to compare use of hospital services by people in prison with a matched sample from the general population. This takes account of people’s demographics, diagnosis history and history of hospital activity in order to find a group of people in the general population who are very similar to those who go into prison.

We found that the prisoner cohort used hospital services significantly less than we would expect compared to people in the general population that they are similar to (the matched controls). Prisoners had fewer outpatient appointments overall, and were 22% more likely to miss them. A&E visits, admissions and elective admissions were also lower.

We've previously shown that people in prisons don't use hospital services as much as we might expect, but we now can say with more certainty that this observation can’t be explained away by people's particular health care needs. People in prison have the same rights to health care, but they don’t use services as much as everyone else, despite the fact that many prisoners have complex needs. 

We hope that this will provide practical information to help commissioners of health care services in prison to more accurately predict the needs of the prisoner population, the kinds of services that should be offered, and the quantity that they should be offered in.