Gender Differences and the Effect of Copayments on the Utilization of Health Care in Prison.

This study examines differences in episodic health care utilization related to copayment fees in prison. Copayments in correctional institutions may affect men and women differently, as there are gender-specific health needs, differences in the frequencies men and women require medical services, and gendered differences in the financial resources at people's disposal inside the prison environment. Survey data and interviews from 140 males and females incarcerated across two prisons revealed copayments were a significant barrier for those seeking medical attention and reduced utilization. Results from content analysis and zero-inflated Poisson regression models demonstrated the copayments were a greater barrier to treatment for women compared to men, even when considering one's financial resources. Race and self-reported physical health were also significantly associated with avoiding care due to copayments.

"Prison Ain't Free Like Everyone Thinks": Financial Stressors Faced by Incarcerated Women.

Most women in prison are poor and suffer from health problems prior to and during incarceration. Policies that impose inmate medical co-payment fees do not consider gender-specific health needs or other financial stressors faced by women in prison. We examine the financial needs and concerns of incarcerated women through the lens of gender and behavioral economics. We conducted individual interviews with 95 women incarcerated in a medium/maximum security prison in the United States. Women described several common financial stressors during confinement: paying for medical care, "working for pennies," staying in contact with loved ones, and relying on others. In an attempt to remain gender neutral, prison polices often do not consider gender-based differences between male and female prisoners. When gender neutrality is applied to financial policies surrounding access to healthcare, incarcerated women are profoundly disadvantaged and left to make consequential trade-offs with scarce financial resources. Our findings provide important insight into financial stressors facing incarcerated women and provide evidence to support the elimination of mandatory medical co-payment fees for incarcerated women.

Variable links within perceived police legitimacy?: fairness and effectiveness across races and places.

This work examines connections between two threads of community residents' perceptions of local police legitimacy, effectiveness and procedural fairness, and how those links depend on race, place, and race/place combinations. Previous works have connected these two threads, but have failed (a) to explore the variability of that connection by race, place, and race/place combinations across communities spanning the urban to suburban to rural continuum or (b) to model mutual influence. An extension of the group position thesis and work on minority views of police practices suggest how these variations might be patterned. Data were derived from a 2003 probability-based sampling survey of household respondents across Pennsylvania (n=1289). Generalized confirmatory factor analysis models built procedural fairness and effectiveness indices for four groups: whites in urban core counties, non-whites in urban core counties, whites in non-urban core counties, and non-whites in non-urban core counties. Non-recursive structural equation models revealed variable impacts of perceived police effectiveness on perceived police fairness and, to a lesser extent, of fairness on effectiveness. Implications for a more structurally and contextually aware understanding of links in police legitimacy models are developed.