Prison Population and Healthcare Models in the USA


In essence, vulnerable populations are viewed and identified on three critical bases. Firstly, it can be used to refer to people whose options in life are overtly few due to the conditions in which the find themselves. Understandably, these conditions might be either natural or artificially encountered. Secondly, they include people who are often coerced when making their decisions since the society finds them to be socially or financially deficient. Lastly, this terms might refer to the people whose right to give informed consent is on the threat of being compromised.

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Description of the Population

This paper focuses on the prison population with a view to apply the Vulnerable Population Conceptual Model. The prison population has been increasingly growing over the years since the 1980s as shown in this table.

Table 1: A table showing the increasing population of the inmates in prison since 1980 to 2016 in intervals of five years (Federal Bureau of Prisons, 2016)

Year Population
1980 24,640
1985 40,330
1990 64,936
1995 100,958
2000 145,125
2005 187,394
2010 210,227
2014 214,149
2016 195,730

In principle, the inmates are part of the vulnerable population based on the fact that they are subject to limitations on daily basis and might face coercion in decision making. Their physical movements and social rights are limited while their programs are scheduled by the management such that the inmates are not included in decision making whatsoever. They therefore follow the decisions by the management due to coercion and the strict requirement to abide. Importantly, the inmates are labeled negatively and hence viewed as offenders. This sets them in a situation where their health and fundamental human needs are at risk of being overlooked. The issue of congestion and limited movement also makes it easy to spread communicable diseases especially during outbreaks. As such, the inmates are at risk of contracting illnesses such as TB and others of similar nature.

Application of the Vulnerable Population Conceptual Model

Leight (2003) indicates that the Vulnerable Population Conceptual Model (VPCM) is a framework that relates the resource availability to relative risks exposed to people as well as their prevalent health conditions. As such, it is concerned about the interconnection that exists among these three fundamental aspects of human lives.

Resource Availability

The availability of resources among inmates is a major challenge when it comes to prison populations. First, the time available to them to interact with their family, friends, and loved ones is very limited. This because the inmates are allowed to only interact during planned visits as shown in the Bureau of Prison programs. Understandably, the ability to allocate time as a resource is fundamentally limited in case of prisons. Secondly, inmates have limited access to information which they require. In most cases, they only have contact with the security personnel rather than the top staff that may have essential information such as their charges and release dates. This implies that access to information as a vital resource in human life is limited. Thirdly, the inmates have limited access to exercise space and time since these are sometimes considered as undeserved equipments for them. In addition, they rarely access psychologists to help them in management of emotions and thoughts.

Relative Risks

According to the above limitations and inadequacy of resources, prison populations find themselves in various risks. The disconnection from the society makes it difficult to maintain their self esteem and relate to each other. As such, this makes it difficult to go along with their colleagues in the prisons leading to wars and conflict. In addition, these factors such as lack of counselors and exercises increase their stress levels. As such, they are exposed to high levels of stress.

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Health Status

As a result of high stress levels among the population and congestion, the prison population is faced by mental illnesses. Cases of depression arise due to continuous exposure to stress and anxiety coupled with the lack of sufficient counseling. Mental illnesses have therefore become a real health challenge among the prison population (Raphael & Stoll, 2009).


It is evident that the prison population is a vulnerable population especially because of financial, physical, and social limitations. Resources such as information, time with their loved ones, and psychological care are also fundamentally limited. This exposes the inmates to high levels of stress. As a result, inmates find themselves at a risk of developing mental illnesses and conditions such as depression.

Summary of US Healthcare Models

Essentially, the US has four fundamental models that it follows in the provision of healthcare services to its citizens. These healthcare models include the National Health Insurance, Bismarck, Out-of-Pocket, and Beveridge. To start with, the beveridge model of healthcare applies the use of taxation to cater for health expenditures. Tax deductions are channeled to provision of healthcare whereby most of the hospitals are actually owned by the state. When it comes to Bismark model of healthcare system, the funds are drawn from payment deductions. These payment deductions are contributed by both the employer and the employee to raise enough funds for the healthcare coverage (Wallace, 2013).

The National Health Insurance, on the other hand, draws funds from the government, but it uses privately owned institutions when it comes to provision of services. In addition, although most countries do not go for a profit-making insurance program, the USA follows an insurance model that makes profits. Lastly, the Out-Of-Pocket model is mostly implemented in developing countries where the capability to establish universal coverage is essentially difficult. In this case, the patients pay from their pockets directly to the institution of service provision. Kulesher and Forrestal (2014) view this system as a classic economic model. In their view, the model is informed and controlled by the forces of supply and demand especially when it comes to pricings as well as cost incurred. In essence, it works on the basis that several patients can combine their efforts to pay for doctor’s services.

Table 2: Tabular representation of the differences of the four basic healthcare models in US

Model Characteristics showing differences
  • Funds come from taxation
  • Hospitals are mostly owned by government
  • Funds are obtained from payroll deductions
  • Hospitals are mostly privately owned
  • Does not make profits
National Health Insurance (US)
  • Government provide funds drawn from citizenry contributions
  • Hospitals used are privately owned
  • Makes profits
  • Funds come from patients directly and hence they are charged upon service pursuit
  • The patient seeks the hospitals of choice either private or government owned. However, government owned hospitals are cheaper due to subsidies
  • Makes profits since it follows supply and demand

Although some of the models such as Bismarck and Beveridge are not as prevalent in the USA as compared to their place of origin, the country shows characteristics aligned to all the four models. However, the insurance model is more prevalent as compared to the rest. Based on the emphasis of insurance-oriented healthcare, I believe that USA will create a more sustainable healthcare system especially with innovative provision such as the Affordable Care Act (Obamacare). As such, it is my view that within the next few years, every citizen will sustainably be assured of coverage as far as their health expenditure is concerned. This is based on the fact that the use of insurance can effectively cover the employed, self-employed, and even the unemployed provided programs are well set.


Federal Bureau of Prisons. (2016). Web.

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Kulesher, R., & Forrestal, E. (2014). International models of health systems financing. JHA Journal of Hospital Administration, 3(4).

Leight, S. (2003). The Application of a Vulnerable Populations Conceptual Model to Rural Health. Public Health Nursing Public Health Nurs, 20(6), 440-448.

Raphael, S., & Stoll, M. A. (2009). Do prisons make us safer?: The benefits and costs of the prison boom. New York: Russell Sage Foundation.

Wallace, L. (2013). A View of Health Care Around The World. Annual Family Medical, 11(84), 1483-1484.

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