Managed care uses a payment strategy such as capitation or discounted fee-for-service and controls costs by monitoring the level of services used. Telemedicine uses videoconferencing technology to connect the prison with a hospital or another health care facility. Telemedicine assists in meeting community standards required by courts for inmate health care. Telemedicine makes primary and specialty health care timely and accessible to isolated rural locations, and reduces the need for offsite transfers. Managed care uses the advantages of this technology to deliver appropriate services and directly cut transportation, personnel, and health costs. The Texas Tech University Health Sciences Center (TTUHSC) provides health services to 33,000 inmates in 28 correctional facilities. Thirteen facilities are connected via a telemedicine hookup and have accomplished more than 3,100 tele-consultations since 1994. TTUHSC has also contracted to provide services to more than 1,000 youths in Texas Youth Commission facilities and has expanded its services to some county and local jails. The system has avoided an estimated $142 million in health costs since its inception in 1993. Costs were $6 per inmate per day in 1993 and $5.25 per inmate per day in 1997. Photographs