Inequalities in Health Service Use among Former Inmates: A Propensity Score Approach

• In Event: The Many Experiences and Consequences of Incarceration

Abstract

Previous research documents that former inmates have worse health service outcomes than never incarcerated adults. Barriers to treatment often exist for newly released prisoners due to high rates of poverty and unemployment, unstable housing and homelessness, low literacy, and family problems. Given the fundamental differences between the inmate and noninstitutionalized populations, this study uses a quasi-experimental design - propensity score matching - to examine different health service outcomes for young adults following incarceration. Using data from the National Longitudinal Study of Adolescent Health (Add Health), this study examines the estimated causal effect of imprisonment on having no health insurance (public or private), using the emergency department as a regular source of care, and having no past year check-up. After adjusting for differential selection into imprisonment, being a former inmate contributes to an increase of 11.5 percentage points for having no insurance coverage, 9.1 percentage point for regular emergency department use, and 4.9 percentage points for not having a past year check-up. Heterogeneous treatment effects for post-release health service outcomes show no effects by race. However, it is argued that black young adults are still the most affected by these negative outcomes precisely because they are most overrepresented among former inmates.

Author

• Kathryn M. Nowotny, University of Colorado Boulder