Inequity in Healthcare Delivery: Barriers Faced by the Newly Released Inmate

Abstract

A disparity in health care exists for individuals accessing primary care following incarceration. Whether due to the myriad of barriers that inhibit people from establishing new care with providers, or the poor perceptions of health care and adverse experiences that have likely had a negative effect on this already marginalized group, recently released prisoners returning to homelessness constitute some of the highest emergency service utilizers in the nation. A mixed-methods intervention study was conducted to identify common barriers that inhibit an individual from accessing care upon jail release and to assess the feasibility of a warm handoff intervention to improve utilization of primary care over emergency services. Participant interviews, along with the researcher’s experiences, highlighted four key barriers to accessing health care upon jail release: navigating the system, wait times for appointments, prioritizing health, and logistic challenges such as transportation and means of making contact. Quantitative results of the study show that there was no significant difference between groups in number of primary care provider appointments or emergency room visits following release. However, qualitative results show support for the warm handoff intervention in overcoming some of the identified barriers and improving relationships with primary health care providers, as well as a desire of participants to increase utilization of primary care over the emergency room. In addition to identifying common barriers for participants and assessing the feasibility of the warm handoff intervention, this study identified the larger systems issues that work to hinder this high-needs, high-utilizer group from receiving necessary health care, such as Medicaid delays and a lack of available providers to serve Medicaid users in an effective and timely manner. The following papers represent: 1) the methodological challenges faced by the researcher in design and implementation of a study conducted inside a jail and immediately following release; 2) a case example to demonstrate the typical pattern for a participant receiving the intervention; and 3) a results paper to outline the details of the study and pertinent findings. Together, these papers demonstrate that while the warm handoff intervention appears to be a step in the right direction for improving access to primary care providers for newly released prisoners, modifications to the intervention are needed and larger societal changes will be necessary in order to truly improve the health and well-being of this highly marginalized population.