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BMC Health Services Research
Published in: BMC Health Services Research 1/2018

Open Access 01-12-2018 | Research article

The determinants of individual health care expenditures in prison: evidence from Switzerland

Authors: Karine Moschetti, Véra Zabrodina, Tenzin Wangmo, Alberto Holly, Jean-Blaise Wasserfallen, Bernice S. Elger, Bruno Gravier

Published in: BMC Health Services Research | Issue 1/2018

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Abstract

Background

Prison health systems are subject to increasing pressures given the specific health needs of a growing and aging prison population. Identifying the drivers of medical spending among incarcerated individuals is therefore key for health care governance in prisons. This study assesses the determinants of individual health care expenditures within the prisons of the canton of Vaud, a large region of Switzerland.

Methods

We use a unique dataset linking demographic and prison stay characteristics as well as objective measures of morbidity to detailed medical invoice data. We adopt a multivariate regression approach to model total, somatic and psychiatric outpatient health care expenditures.

Results

We find that chronic infectious, musculoskeletal and skin diseases are strong predictors of total and somatic costs. Schizophrenia, neurotic and personality disorders as well as the abuse of illicit drugs and pharmaceuticals drive total and psychiatric costs. Furthermore, cumulating psychiatric and somatic comorbidities has an incremental effect on costs.

Conclusion

By identifying the characteristics associated with health care expenditures in prison, this study constitutes a key step towards a more efficient use of medical resources in prison.
Footnotes
1
For further details on the Swiss health and insurance systems, see e.g., the review published by the OECD and the WHO [60].
 
2
Ordinary least squares of log-transformed expenditures are commonly used and may be efficient with heavy-tailed data [40]. However, this method poses the retransformation problem to obtain interpretable results, especially in the presence of heteroscedasticity, and is inappropriate for zero data. Breusch-Pagan and White tests detect complex heteroscedasticity of log-scale residuals, and the Shapiro-Wilk test rejects normality (all p-values < 0.000).
 
3
We experimented with models including interaction terms between disease indicators, but these led to severe collinearity issues.
 
4
Plotting the mean residuals by deciles of costs indicates that the models consistently over-predict in the upper decile. The Gamma model in particular downweighs the errors at the high end of costs compared to the Poisson model, which gives equal weight to errors across the whole range. Therefore, the Gamma fits high-cost observations worse [41].
 
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Metadata
Title
The determinants of individual health care expenditures in prison: evidence from Switzerland
Authors
Karine Moschetti
Véra Zabrodina
Tenzin Wangmo
Alberto Holly
Jean-Blaise Wasserfallen
Bernice S. Elger
Bruno Gravier
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2018
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-018-2962-8

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