The evaluation focused on State administration of inmate health care delivery, with particular emphasis on the acquisition and allocation of health care resources, health care program development, cost-effective use of existing resources, staff development, and the establishment of effective medical and mental health care programs in secure custodial institutions. The Division of Health Services contracts with five community hospitals for acute medical-surgical beds and clinic diagnosis and treatment. The evaluation found that few incentives exist for these hospitals to increase service availability to correctional institutions, and similar resistance is encountered in obtaining specialty physician services. Overcrowding has resulted in widespread use of medical service areas for general housing. Monitoring and service utilization is inadequate, and return on the health care dollar is difficult to determine. Half of the facility health care units were understaffed, and staff are unevenly deployed. Further, no formal staff orientation or inservice training programs exist. Extraordinary security measures impede inmate access to health care and contribute to inefficiency. Dental services are generally poorly utilized and equipped. A regional service plan tends to result in a concentration of mentally disordered inmates in a few facilities, and existing services are inadequate to the needs of mentally retarded and substance-abusing inmates. Major recommendations for improving services are provided. Supplemental findings and materials are appended. 34 footnotes.