Faced with explosive growth in its prison population and a legal mandate
to improve medical care for incarcerated offenders, the state of Texas implemented
a novel correctional managed health care program in 1994. The organizational
structure of the program is based on a series of contractual relationships
between the state prison system, 2 of the state's academic medical centers,
and a separate governing body composed of 9 appointed members, which include
5 physicians. All medical, dental, and psychiatric care for more than 145 000
offenders, incarcerated under the jurisdiction of the Texas Department of
Criminal Justice, is provided by the University of Texas Medical Branch and
Texas Tech University Health Sciences Center. The health delivery system is
composed of several levels of care, including primary ambulatory care clinics
in each prison unit, 16 infirmaries at strategic locations throughout the
state, several regional medical facilities, and a dedicated prison hospital
with a full range of services. Specialized treatment programs have been established
at various units for patients with chronic conditions, such as hypertension,
diabetes mellitus, major psychiatric disorders, hepatitis, and human immunodeficiency
virus infection. Significant improvements in health outcomes have occurred
since the managed care program was established.
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