The cost of providing prison health services has been debated since 1774, when the Health of Prisoners Act was passed by the British parliament.1 That debate continues now, although measuring how much taxpayers spend on prisoners is notoriously difficult. Nevertheless, the annual median cost of incarcerating a prisoner in secure custody in 2003-4 was about $28 000 (£15 800, €23 400) per state prisoner in the United States,2 $45 000 in Australia,3 and $53 000 in Britain.4 ^w1 US state prisoners' annual healthcare costs averaged 12% of total costs (around $3350). With rising rates of incarceration,^w2 increasing public support for penal policies,^w3 greater needs among inmates for health care,5 and limited budgets,^w4 prison health care is becoming harder to fund adequately.

In September 2002, the British government announced that it would transfer budgetary responsibility …