BOP Urged to Understand, Control Health Costs

BOP Urged to Understand, Control Health Costs

The Federal Bureau of Prisons should improve its analysis of skyrocketing health care costs for federal prisons, the Government Accountability Organization (GAO) says in a recently released report. The report indicated costs rose about 36% on a per-capita basis between 2009 to 2016. GAO urged BOP to identify the main causes and to evaluate the effectiveness of planning and cost control measures.

Health care costs are far from a minor budget item for BOP: over the past eight fiscal years, BOP has spent over $9 billion on inmate health care (not including psychological services or buildings and maintenance), with outlays climbing about 37% over that period. The report notes that BOP has identified such factors as the aging prison population, climbing pharmaceutical prices (especially for new hepatitis C drugs), and increased costs for outside medical services as reasons for rising healthcare costs.

But, GAO further observes, the agency “lacks or does not analyze certain health care data necessary to understand and control its costs.” BOP has data showing how much it spends overall for healthcare but does not have utilization data, so it cannot tell how much it’s spending per inmate or for specific healthcare services.

Further, although the agency has come up with potential solutions for getting utilization data, it has not yet analyzed the cost-effectiveness of those steps in order to see which approach would be the most effective.

Another problem the report indicated is that BOP had not analyzed its spending data, to see what its facilities are buying, from whom, and how much they spend. Nor, despite some efforts—such as nationwide contracts and interagency cooperative efforts—has it analyzed spending trends, which it needs to do to get more useful information on acquisition and service costs. The report noted that individual BOP institutions may acquire the same equipment at widely different prices and terms.

Since 2009, while the agency has planned or carried out healthcare cost control measures, it has yet to evaluate the effectiveness of those measures. Of 16 cost-control programs BOP identified, the agency could only document cost savings from one. BOP’s strategic planning process still lacks important elements, such as a mechanism for gauging progress toward its objectives, and ways to identify necessary resources and spending.

A case in point to illustrate the impact of insufficient planning: BOP had planned to realize cost savings by implementing mail-order pharmacy services, but that was delayed for a number of years. The agency explained that in some years, it had the space needed for the plan, and in other years, it had the money needed but never had both in the same year.

The GAO report recommended five main improvements; BOP says it accepts them all. They include: conducting a cost-effectiveness analysis to identify the best way to collect data on how healthcare is being utilized; analyzing how healthcare funds are being spent; evaluating the effectiveness of cost-control steps BOP is taking; and upgrading parts of its planning activities.

The GAO report, titled Bureau of Prisons: Better Planning and Evaluation Needed to Understand and Control Rising Inmate Heath Care Costs, was requested by two Senate committees and released on July 31.

This article first appeared on Blogcritics.

Christopher Zoukis is an outspoken prisoner rights and correctional education advocate who is incarcerated at FCI Petersburg Medium in Virginia. He is an award-winning writer whose work has been published widely in major publications such as The Huffington Post, Prison Legal News, New York Daily News, and various other print and online publications. Learn more about Christopher Zoukis at and