One prisoner alone ran up a $938,000 hospital bill during three months of care recently. "Inmates do have the guaranteed right to health care and we have some very sick people," said Department of Corrections spokesman Brian Corbett.

State officials say a new arrangement with the State Employees Insurance Board and Blue Cross/Blue Shield could trim prison health costs by $4 million to $6 million a year.

"Where the savings are achieved is through better contracting prices with hospitals," said William Ashmore, executive director of the State Employees Insurance Board.

The board, which handles health insurance for state workers and retirees, is administering the arrangement to give prisons the deep discount that Blue Cross/Blue Shield receives from hospitals when a state worker is treated.

Previously, every time a prisoner needed treatment in a hospital, DOC paid the hospital's sticker price, receiving none of the discounts given to private insurers and government programs such as Medicaid and Medicare. The lower rates began Dec. 1.

While the deal should cut off-site expenses, the prisons face additional health-related costs because of an aging inmate population and growing numbers of chronically ill inmates.

Among additional expenses over the last few years:

The three-year contract with the private company that provides medical care inside prisons grew from $89 million for 2001 to 2003 to $143 million for 2004 to 2006.

A 2005 contract with Just Care, a South Carolina faith-based prison/hospital housing five chronically ill prisoners, has cost $310,000 since May.

Payments to medical monitors who oversee federal court-ordered improvements in health services at three prisons are $232,000.

Off-site treatment at hospitals and clinics has doubled in five years to an estimated $13 million to $15 million for fiscal 2005.

Older prisoners

The growth in the number of older prisoners comes from tough-on-crime measures such as repeat offender laws, as well as overall increases in the state's prison population.

Alabama incarcerates 3,089 prisoners ages 51 and older, a 62 percent jump from the 1,925 locked up in 2001. The population of prisoners 60 and older climbed 55 percent in that period.

"That's a nationwide phenomenon that's been going on for a number of years," said Edward Harrison, president of the National Commission on Correctional Health Care, an organization that works to improve health care in prisons and jails and provides accreditation standards.

"They're staying in the system longer, and being in a closed system like a prison can be pretty tough on the body," Harrison said.

Experts in prison medical care often see prisoners in their 40s with the physical wear and tear of someone much older. Prisoners tend to suffer from infectious diseases more than others, to live harder and come from poorer backgrounds where access to health care was sketchy. Plus, they have the same ailments that cause spiraling health care costs everywhere - diabetes, renal failure, heart disease, cancer and asthma.

"Health care costs are a big ticket item in corrections just like they are in the free world," Harrison said.

Better therapies continually become available. Though more expensive, the new medicines become the standard of care. "So we're obligated to use the proven better methods," Harrison said.

Alabama's cost per prisoner historically has been lower than other states'. In 2002, the state spent about $9,500 per prisoner per year, compared with a national average of $22,700, according to the Corrections Yearbook, a publication of the Criminal Justice Institute.

Too much thrift created problems, however, including a spate of class-action lawsuits that the state was forced to settle over unconstitutionally poor medical care. Improved medical and mental health care are making prison penny-pinching tougher, and the costs consume about 25 percent of the DOC's $312 million general fund appropriation. Alabama's current per-prisoner costs exceed $12,000 a year.

Ashmore said the plan to stem costs through the State Employees Insurance Board has cost some administrative time and required him to hire two new employees. In addition, the state pays $2 per inmate per month, about $670,000 a year at the current inmate count of 27,800. There are no premiums, but Blue Cross/Blue Shield will charge 5 percent of each claim as a processing fee, Ashmore said.

Even with the fees, officials are convinced the state can save millions based on the board's comparisons between the DOC's historical hospital admission costs and what those same admissions would cost under Blue Cross/Blue Shield's discounted rate.

The deal could allow DOC to stop using Just Care, which charges $280 to $400 per prisoner per day. The rate is much higher than other private prisons because the South Carolina facility offers specialized medical care for the sickest prisoners. One suffers from HIV and cancer, another needs regular dialysis.

There are people who would otherwise be continuously in and out of hospitals, said Layne Finlay, special projects coordinator with the Alabama Department of Finance, which has been investigating prison costs.

Also, before contracting with Just Care, the state had to pay security officers to guard hospitalized inmates. Just Care's fees cover security as well as medical treatment, Finlay said.

Records in the state Comptroller's Office show the DOC has renewed the company's contract through fiscal 2006, at a cost of up to $1.2 million.

Harrison, at the National Commission on Correctional Health Care, said Alabama's approach in linking inmate care to the state insurance plan could be an effective strategy, but he has not heard of any other states trying it.

A similar cost-saving measure used in Massachusetts and just passed in Colorado requires hospitals to give the state Medicaid rates for prisoner care. Kansas is considering such a measure, Harrison said.

The commission recommends states take it a step further and let Medicaid, the federal-state health insurance program for poor people, cover prisoners. Because many were on Medicaid before their incarceration, the background and records would follow them into prison, saving money and time.

"We think that would be a big cost-saving measure to the states," he said.

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