Until the 1970s, a sentence to imprisonment not only deprived a person of liberty, but also put the person's health at risk. Medical care was inadequately available and often was primitive. This situation changes when Federal courts intervened and required improvements in inmate health care. The result was the establishment of rights to adequate care, the promulgation of standards, the expansion of medical staffs, and the use of health providers in the surrounding community to fill gaps. Spending for prisoners' health care rose dramatically as a result. Prison administrators began to use various managed care procedures to allocate resources in less costly and more efficient ways. These procedures included efforts to buy needed goods and services in the larger health care marketplace at more advantageous prices, establishing controls and incentives to reduce unnecessary care, and contracting with private companies to manage and deliver care. Prisoners are currently the only persons in the United States with a constitutional right to adequate health care. Support for government-funded care of prisoners may become more precarious if free citizens continue to lack similar legal rights and access to universal health care. Footnotes and 88 references (Author abstract modified)