A mixed funding approach can help meet the urgent requirement for a level of health care in prison commensurate with need and equivalent to community standards

Consistent with global literature,1 prisoners in Australia experience profound health disparities relative to those who have not been incarcerated, with a disproportionate burden of mental illness, chronic and communicable diseases.2,3 Many prisoners have complex histories of disadvantage encompassing family violence, unstable housing, limited education, unemployment and economic adversity. Risky health-related behaviours including smoking, illicit drug use, harmful alcohol consumption and unsafe sexual practices are common in incarcerated populations.2

Correctional settings are uniquely placed to detect health problems, initiate care and promote health in a way that is unlikely to occur in the community, with important public health implications for the communities to which prisoners return.4 It is paradoxical, therefore, that prisoners are excluded from Australia’s universal health care scheme — Medicare — while incarcerated. Instead, health care for prisoners is transferred to state and territory government departments for the duration of their incarceration.

Some of Australia’s peak health and medical advocacy groups have criticised this exclusion, arguing that it transgresses human rights, results in suboptimal care, and perpetuates the cycle of ill health and disadvantage.5,6 Although these groups have called for reform to the legislation that underpins this exclusion, a way forward has not been clearly articulated. In this article, we outline the legal basis for prisoners’ exclusion from Medicare, articulate key arguments for reform and offer some pragmatic next steps, informed by an understanding of the legislation and an appreciation that wholesale replacement of prison health services with Medicare is neither workable nor desirable.