The report provides a breakdown of some health care costs by type of service, the health care delivery method, and whether the inmates receiving specialty health care were striker inmates. The report also describes the impact of staff vacancies on overtime and discusses California Prison Health Care Services' plans for containing health care costs. The study found that striker inmates compose 25 percent of the inmate population as of April 2009. Striker inmates receive sentences that average 9 years longer than other inmates, resulting in approximately $19.2 billion in additional costs. Striker inmates include many individuals currently convicted for an offense that is not a strike, were convicted of committing multiple serious or violent offenses on the same day; and some committed strikeable offenses as a juvenile. Inmate health-care costs are significant in the housing of inmates. In fiscal year 2007-08, $529 million was incurred for contracted services by specialty health care providers. Thirty percent of the inmates receiving such care cost more than $427 million. The costs for the remaining 70 percent averaged just over $1,000 per inmate. The costs for those inmates who died during the last quarter ranged from $150 for one inmate to more than $1 million for another. A significant portion of the increased workload due to medical guarding and transportation is addressed through overtime. The large leave balances of custody staff will eventually cost the State from $546 million to more than $1 billion. Recommendations and agency comments