The contractual model for prison health care.

In New York City, the Department of Health is responsible for providing health services to 8 correctional facilities which receive 60,000 admissions annually. A large component of this prison health system is a contract with Montefiore Hospital, a voluntary institution, to provide medical services to the population on Rikers Island, a penal complex. This contractual agreement is unique in that an operating entity, Monefiore Hospital, has agreed to provide a "package" of health services to a defined prisoner population. The City agreed to reimbruse to the Hospital for the three year term of the contract, a total amount not to exceed +11.7 million. Because of delays in renovation of the prison facilities, for the majority of the period of the three year contract, only two prisons were served via the contractual route. Since 1973, the program has provided a range of services including screening of new prisoners, primary, emergency, infirmary and limited speciality care. Major improvements in laboratory and radiology services were implemented. The early experience with this program indicates that in this setting the contractual model possesses a number of distinct advantages over the direct delivery of prison health services. Disadvantages include a significantly higher cost.