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The establishment and prospect of health indicators for inmates in correctional institutions
+
MODEL
Journal of the Formosan Medical Association (2016) xx, 1e2
Available online at www.sciencedirect.com
ScienceDirect journal homepage: www.jfma-online.com
PERSPECTIVES
The establishment and prospect of health indicators for inmates in correctional institutions Yi-Chi Hung a, Jih-Chiao Chu a,b,* a b
Department of Social Insurance, Ministry of Health and Welfare, Taiwan, ROC Department of Health-Business Administration, Hungkuang University, Taiwan, ROC
Received 27 April 2016; received in revised form 3 October 2016; accepted 3 October 2016
The Second Generation National Health Insurance (2G-NHI) was implemented in 2013, nearly two decades after the original introduction of National Health Insurance (NHI) in 1995. Following the amendment, it was the first time that inmates in correctional institutions were recruited as NHI beneficiaries. To improve the new 2G-NHI program, the Ministry of Health and Welfare established the 2G-NHI All-Round Review Panel in March 2013, and listed “NHI enrollment and healthcare for the inmates” as one of the key review items. Using an in situ review method, we held four half-day forums for the exchange of opinions, collected information through field visits to four correctional institutions, and identified preliminary problems with other related government institutions. In this process, we identified various problems in the initial stage of inmates’ NHI healthcare program, such as the lack of medical equipment in prisons and the inmates’ inability to pay out-of-pocket fees. According to the report1 by the 2G-NHI All-Round Review Panel, the current NHI healthcare provided to inmates is relatively successful. The panel suggested that the current operating model could be maintained and monitored. However, the improvement in inmates’ health status following their NHI enrollment remains to be determined.
Conflicts of interest: The authors have no conflicts of interest relevant to this article. * Corresponding author. Ministry of Health and Welfare, Number 488, Section 6, Zhongxiao East Road, Nangang District, Taipei City, Taiwan, ROC. E-mail address: [email protected] (J.-C. Chu).
Based on the panel’s suggestion that the health status of inmates should be evaluated through long-term observations and evidence-based analyses, relevant departments of the Ministry of Health and Welfare are now engaged in extensive research and discussion. By using the available statistical data of NHI and other public affairs, the following three indicators were preliminarily established. (1) Prevalence of scabies: Infectious conditions are fueled by communal living and overcrowding in most correctional institutions.2 Scabies, one of the most common contagious skin conditions, spreads rapidly in crowded environments. Therefore, the prevention of a scabies outbreak is especially important in correctional institutions. Further, the monitoring of inmates’ prevalence of scabies reflects not only the environmental hygiene in correctional institutions, but also the effectiveness of lifestyle management and medical intervention implemented by such institutions. (2) Utilization of emergency services: Compared to general beneficiaries who can obtain medical service freely and engage in inappropriate utilization of emergency medical services,3 inmates’ emergency utilization might be correlated to their real health status. Inmates’ needs for emergency medical attention due to acute injury or illness could be reduced by controlling possible illnesses through periodic visitations, preventing the occurrence of the sudden onset of diseases, and maintaining favorable lifestyles.
http://dx.doi.org/10.1016/j.jfma.2016.10.003 0929-6646/Copyright ª 2016, Formosan Medical Association. Published by Elsevier Taiwan LLC. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Please cite this article in press as: Hung Y-C, Chu J-C, The establishment and prospect of health indicators for inmates in correctional institutions, Journal of the Formosan Medical Association (2016), http://dx.doi.org/10.1016/j.jfma.2016.10.003
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MODEL
2
Y.-C. Hung, J.-C. Chu (3) Effectiveness of tuberculosis (TB) case management: Similar to scabies, TB is a transmittable disease that should be effectively controlled in correctional institutions and other crowded environments. According to statistics in the All-Round Report, the detection rate of TB in inmates is higher than the national average, suggesting the importance of TB prevention for inmates. It is necessary for inmates to take chest X-ray screening of TB when they are be incarcerated in Taiwan. If a TBinfected inmate was detected, then the isolation measures and appropriate treatments intervene. Referring to the World Health Organization report, an efficient management system is one of the basic components of the Directly Observed Treatment, Short-Course strategy.4 As inmates may move around through inter-prison transfers, initial incarceration, or discharge, the continual treatment for and effective control of TB, as well as the management of TB cases, are extremely challenging. Therefore, an indicator that could monitor the effectiveness of managing TB cases in correctional institutions would not only complete the treatment of inmates, but also prevent the spread of TB.
Since the inclusion of inmates into the NHI scheme, the stationing of NHI-contracted medical institutions in correctional institutions to provide medical services has been a novel and challenging task.5 Moreover, the environment, lifestyle, and health status of inmates and the population structure of correctional institutions are considerably different to those of general beneficiaries. Thus, substantial effort needs to be directed at combining public health services to enhance the health of inmates.6 In this context, we have attempted to establish indicators that can be used to monitor the long-term health conditions of inmates. In addition to the three indicators proposed in this article, related agencies are currently engaged in extensive research and discussions to propose more indicators and conduct observations. Although only several indicators have currently been proposed and a small number of observations have been conducted, making it difficult to assess the improvements in inmates’ health conditions immediately (see Table 1), we hope to develop a
Table 1 Statistics indicators.
of
the
inmates’ 2012
health 2013
status 2014
Prevalence of scabies NA 11.7 11.1 Utilization of emergency services NA 0.50 0.53 Effectiveness of TB case management 93.78 91.90 87.01 Data are presented as %. TB Z tuberculosis. Note. Definitions of indicators: (1) Prevalence of Scabies Z Annual Number of Scabies Cases/Annual Number of Inmates. (2) Utilization of Emergency Services Z Annual Number of Emergency Visits/Annual Number of Outpatient Visits. (3) Effectiveness of TB Case Management Z Annual Number of Completed Management of TB Cases/Annual Number of TB Cases.
more comprehensive monitoring and assessment method to better monitor the health status of inmates. This data can then be used as a reference for adjusting matters such as medical services, public hygiene, and prison management, ultimately achieving the goal of full enrollment of NHI for inmates to improve their health.
References 1. Second Generation NHI All-Round Report. Second Generation NHI All-Round Review Panel, Taiwan, ROC. 2014 [In Chinese]. 2. Lindquist CH, Lindquist CA. Health behind bars: utilization and evaluation of medical care among jail inmates. J Community Health 1999;24:285e303. 3. Huang JA, Weng RH, Lai CS, Hu JS. Exploring medical utilization patterns of emergency department users. J Formos Med Assoc 2008;107:119e28. 4. World Health Organization (WHO). The Stop TB Strategy: building on and enhancing DOTS to meet the TB-related millennium development goals. Geneva: WHO; 2006. 5. Chen MS. Health insurance in the prisone a solution that created its own problems. Ann Public Health Res 2015;2:1031. 6. Chen MS, Huang JT, Chung CH, Hsu MT, Chen JS. Evaluating the policy of covering the inmates under the National Health Insurance: an evaluative study based on document analysis of the international literature and preliminary evidence. J Corrections 2016;5:75e103 [In Chinese: English abstract].
Please cite this article in press as: Hung Y-C, Chu J-C, The establishment and prospect of health indicators for inmates in correctional institutions, Journal of the Formosan Medical Association (2016), http://dx.doi.org/10.1016/j.jfma.2016.10.003
MODEL
Journal of the Formosan Medical Association (2016) xx, 1e2
Available online at www.sciencedirect.com
ScienceDirect journal homepage: www.jfma-online.com
PERSPECTIVES
The establishment and prospect of health indicators for inmates in correctional institutions Yi-Chi Hung a, Jih-Chiao Chu a,b,* a b
Department of Social Insurance, Ministry of Health and Welfare, Taiwan, ROC Department of Health-Business Administration, Hungkuang University, Taiwan, ROC
Received 27 April 2016; received in revised form 3 October 2016; accepted 3 October 2016
The Second Generation National Health Insurance (2G-NHI) was implemented in 2013, nearly two decades after the original introduction of National Health Insurance (NHI) in 1995. Following the amendment, it was the first time that inmates in correctional institutions were recruited as NHI beneficiaries. To improve the new 2G-NHI program, the Ministry of Health and Welfare established the 2G-NHI All-Round Review Panel in March 2013, and listed “NHI enrollment and healthcare for the inmates” as one of the key review items. Using an in situ review method, we held four half-day forums for the exchange of opinions, collected information through field visits to four correctional institutions, and identified preliminary problems with other related government institutions. In this process, we identified various problems in the initial stage of inmates’ NHI healthcare program, such as the lack of medical equipment in prisons and the inmates’ inability to pay out-of-pocket fees. According to the report1 by the 2G-NHI All-Round Review Panel, the current NHI healthcare provided to inmates is relatively successful. The panel suggested that the current operating model could be maintained and monitored. However, the improvement in inmates’ health status following their NHI enrollment remains to be determined.
Conflicts of interest: The authors have no conflicts of interest relevant to this article. * Corresponding author. Ministry of Health and Welfare, Number 488, Section 6, Zhongxiao East Road, Nangang District, Taipei City, Taiwan, ROC. E-mail address: [email protected] (J.-C. Chu).
Based on the panel’s suggestion that the health status of inmates should be evaluated through long-term observations and evidence-based analyses, relevant departments of the Ministry of Health and Welfare are now engaged in extensive research and discussion. By using the available statistical data of NHI and other public affairs, the following three indicators were preliminarily established. (1) Prevalence of scabies: Infectious conditions are fueled by communal living and overcrowding in most correctional institutions.2 Scabies, one of the most common contagious skin conditions, spreads rapidly in crowded environments. Therefore, the prevention of a scabies outbreak is especially important in correctional institutions. Further, the monitoring of inmates’ prevalence of scabies reflects not only the environmental hygiene in correctional institutions, but also the effectiveness of lifestyle management and medical intervention implemented by such institutions. (2) Utilization of emergency services: Compared to general beneficiaries who can obtain medical service freely and engage in inappropriate utilization of emergency medical services,3 inmates’ emergency utilization might be correlated to their real health status. Inmates’ needs for emergency medical attention due to acute injury or illness could be reduced by controlling possible illnesses through periodic visitations, preventing the occurrence of the sudden onset of diseases, and maintaining favorable lifestyles.
http://dx.doi.org/10.1016/j.jfma.2016.10.003 0929-6646/Copyright ª 2016, Formosan Medical Association. Published by Elsevier Taiwan LLC. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Please cite this article in press as: Hung Y-C, Chu J-C, The establishment and prospect of health indicators for inmates in correctional institutions, Journal of the Formosan Medical Association (2016), http://dx.doi.org/10.1016/j.jfma.2016.10.003
+
MODEL
2
Y.-C. Hung, J.-C. Chu (3) Effectiveness of tuberculosis (TB) case management: Similar to scabies, TB is a transmittable disease that should be effectively controlled in correctional institutions and other crowded environments. According to statistics in the All-Round Report, the detection rate of TB in inmates is higher than the national average, suggesting the importance of TB prevention for inmates. It is necessary for inmates to take chest X-ray screening of TB when they are be incarcerated in Taiwan. If a TBinfected inmate was detected, then the isolation measures and appropriate treatments intervene. Referring to the World Health Organization report, an efficient management system is one of the basic components of the Directly Observed Treatment, Short-Course strategy.4 As inmates may move around through inter-prison transfers, initial incarceration, or discharge, the continual treatment for and effective control of TB, as well as the management of TB cases, are extremely challenging. Therefore, an indicator that could monitor the effectiveness of managing TB cases in correctional institutions would not only complete the treatment of inmates, but also prevent the spread of TB.
Since the inclusion of inmates into the NHI scheme, the stationing of NHI-contracted medical institutions in correctional institutions to provide medical services has been a novel and challenging task.5 Moreover, the environment, lifestyle, and health status of inmates and the population structure of correctional institutions are considerably different to those of general beneficiaries. Thus, substantial effort needs to be directed at combining public health services to enhance the health of inmates.6 In this context, we have attempted to establish indicators that can be used to monitor the long-term health conditions of inmates. In addition to the three indicators proposed in this article, related agencies are currently engaged in extensive research and discussions to propose more indicators and conduct observations. Although only several indicators have currently been proposed and a small number of observations have been conducted, making it difficult to assess the improvements in inmates’ health conditions immediately (see Table 1), we hope to develop a
Table 1 Statistics indicators.
of
the
inmates’ 2012
health 2013
status 2014
Prevalence of scabies NA 11.7 11.1 Utilization of emergency services NA 0.50 0.53 Effectiveness of TB case management 93.78 91.90 87.01 Data are presented as %. TB Z tuberculosis. Note. Definitions of indicators: (1) Prevalence of Scabies Z Annual Number of Scabies Cases/Annual Number of Inmates. (2) Utilization of Emergency Services Z Annual Number of Emergency Visits/Annual Number of Outpatient Visits. (3) Effectiveness of TB Case Management Z Annual Number of Completed Management of TB Cases/Annual Number of TB Cases.
more comprehensive monitoring and assessment method to better monitor the health status of inmates. This data can then be used as a reference for adjusting matters such as medical services, public hygiene, and prison management, ultimately achieving the goal of full enrollment of NHI for inmates to improve their health.
References 1. Second Generation NHI All-Round Report. Second Generation NHI All-Round Review Panel, Taiwan, ROC. 2014 [In Chinese]. 2. Lindquist CH, Lindquist CA. Health behind bars: utilization and evaluation of medical care among jail inmates. J Community Health 1999;24:285e303. 3. Huang JA, Weng RH, Lai CS, Hu JS. Exploring medical utilization patterns of emergency department users. J Formos Med Assoc 2008;107:119e28. 4. World Health Organization (WHO). The Stop TB Strategy: building on and enhancing DOTS to meet the TB-related millennium development goals. Geneva: WHO; 2006. 5. Chen MS. Health insurance in the prisone a solution that created its own problems. Ann Public Health Res 2015;2:1031. 6. Chen MS, Huang JT, Chung CH, Hsu MT, Chen JS. Evaluating the policy of covering the inmates under the National Health Insurance: an evaluative study based on document analysis of the international literature and preliminary evidence. J Corrections 2016;5:75e103 [In Chinese: English abstract].
Please cite this article in press as: Hung Y-C, Chu J-C, The establishment and prospect of health indicators for inmates in correctional institutions, Journal of the Formosan Medical Association (2016), http://dx.doi.org/10.1016/j.jfma.2016.10.003