Systems of Care and Systems of Corrections: Spillover Effects from Incarceration to Health Care

Incarceration research catalogues its direct negative impact on former inmates and their families, though the effects of punishment clearly spill over to affect broader economic and political institutions as well. To further expand the scope of incarceration research, this study examines spillover effects between state-level incarceration rates and the functioning of the U.S. health care system. Using a large individual-level data set matched to state-level data, we find that individuals residing in states with a larger number of former prison inmates have diminished access to care, less access to specialists, reduced physician trust, and less satisfaction with the care they receive, net of a variety of individual-level control variables. These spillover effects are deep in the sense that they affect even those least likely to be personally affected by incarceration, including the insured, those over 50, women, non-Hispanic whites, and those with incomes far exceeding the federal poverty threshold. These effects establish the intersection of systems of care and corrections, linked by financial and administrative mechanisms. These intersections lead to spillover effects of unusually wide breadth.