Voluntary Accreditation and Healthcare Quality: Evidence from a Randomized Controlled Trial in U.S. Jails
Year: 2025
Type: report
Study designs: Randomized Controlled Trial, Clinical Trial
Abstract: The U.S. has one of the highest incarceration rates in the world, with over seven million admissions to jails each year.Incarcerated individuals are the only group in the U.S. that have a constitutional right to receiving "reasonably adequate" health care.Yet, there is little oversight and funding for health care in jails, where adverse health outcomes such as mortality are known to be underreported.This setting is also one characterized by limited information among law enforcement regarding health care standards, and coordination problems between custody and medical staff who together produce inmate health.We randomize the offer of health care accreditation, which provides education and training on evidence-based industry standards, to 44 jails across the U.S. We find accreditation improves quality standards and reduces mortality among the incarcerated, which is three times higher among control facilities than official estimates suggest.Surveys of staff indicate that accreditation improves coordination between health and custody staff, and audits of medical records find enhanced screening of inmates upon admission.These health gains are realized alongside suggestive reductions in six-month recidivism, such that accreditation is highly cost effective.
DOI: 10.3386/w33357
Authors: Marcella Alsan, Crystal Yang
Language: English
Subfield: Sociology and Political Science
Field: Social Sciences
Domain: Social Sciences
Open Access status: green
Funders: Arnold Ventures, Harvard Kennedy School
OpenAlex ID: W4406315983