When I was an undergraduate, before I switched to pre-med, I was an economics major. Maybe because of that training, when I look at jail medical practices, I tend to look at all of the costs of medical practice, not just the monetary costs. For example, the total cost of providing a medication to a patient in the jail includes the cost of the medication (of course), but it also includes the cost of the various people, like nurses, pharmacists, deputies and practitioners, who spend time creating the prescription. Thinking of costs in this way can change our perspective of what something “costs.”
Consider the case of the man with heartburn. We’ll call him “Jeffrey.” He doesn’t know it, but he is about to go to jail. Before Jeffrey goes to jail, if he wants to purchase something like ranitidine (Zantac) for his heartburn, he would go to a store and buy it. He doesn’t need to see a medical professional. He doesn’t need a prescription. In most places, he doesn’t even need to wait—convenience stores sell ranitidine 24/7. The monetary price Jeffrey will pay for 50 tablets of ranitidine at the store is around $7.00. The cost in terms of time is how long it takes him to run to the store. The total cost in time to the store to provide the ranitidine to Jeffrey is 30 seconds—how long it took the store clerk to ring up the sale.
Now think of the same guy in jail. Jeffrey still has heartburn. Let’s say he still has money—now in his commissary account. He is still willing to buy ranitidine. But ranitidine is not on the jail commissary list. He can buy Ramen noodles or a Snickers bar, but not ranitidine. In order to get ranitidine, he has to put in a “Request for Medical Care” form. What happens now varies from jail to jail and prison to prison. I am going to present a typical jail scenario.
The act of requesting non-emergent medical care costs Jeffrey $10.00. The form is then triaged by a nurse and Jeffrey is scheduled to see a practitioner. Since the clinics are crowded, the appointment is made for five days hence. In the meantime, he continues to have heartburn. On the scheduled day, he comes to the medical clinic. He waits, say, an hour in the waiting area. He then has vitals taken by a nurse. The practitioner, unsurprisingly, orders a prescription of ranitidine from the pharmacy for Jeffrey. The order is sent to the pharmacy and is delivered the next day. It is paid for from the jail medical budget.