THE SECOND PURPOSE OF THE STUDY WAS TO ASSESS THE IMPACT OF INVOLVEMENT IN THE AMA PROGRAM ON IMPROVING JAIL HEALTH CARE DELIVERY SYSTEMS AS WELL AS THE COSTS OF SUCH IMPROVEMENTS. PARTICIPANT JAIL SELECTION WAS DONE BY MEANS OF A QUESTIONNAIRE DETERMINING THEIR PRACTICES, AND THE FINAL SELECTION WAS MADE FROM THE MIDDLE RANGE OF INITIAL COMPLIANCE WITH AMA STANDARDS, I.E., MEETING AT LEAST 40 BUT LESS THAN 80 PERCENT OF THE STANDARDS. IN-DEPTH STRUCTURED INTERVIEWS WERE CONDUCTED WITH KEY PEOPLE AT EACH OF THE 10 FACILITIES AT THE BEGINNING AND AT THE END OF THE STUDY. EACH JAIL WAS ASKED TO MAINTAIN THREE STATISTICAL FORMS AND ONE INFORMATION SHEET FOR THE DURATION OF THE STUDY. THE RECORDED STATISTICS DEALT WITH JAIL POPULATION CHARACTERISTICS, TRANSPORTING INMATES OUTSIDE THE JAIL FOR HEALTH CARE REASONS, THE NUMBER AND TYPE OF HEALTH CARE SERVICES PROVIDED, AND CHANGES MADE IN THE HEALTH CARE DELIVERY SYSTEM USED. IN ADDITION, INMATES ATTITUDES TO HEALTH CARE WERE ALSO MEASURED WITH QUESTIONNAIRES. HEALTH CARE COST DATA WAS PROVIDED BY EACH JAIL DOCUMENTING OUTLAYS FOR EIGHT AREAS OF HEALTH CARE EXPENSE. BASED ON THESE DATA, THE REPORT CONTAINS TEN EVALUATIONS, DESCRIBING THE PRE-PROGRAM PICTURE AT EACH JAIL IN TERMS OF GENERAL CHARACTERISTICS, HEALTH CARE DELIVERY, AND MEDICAL, ECONOMIC AND POLITICAL ENVIRONMENT. THE PROGRESS MADE AT EACH JAIL AND THE FACTORS CONTRIBUTING TO IT ARE EVALUATED. IN SUMMARY, THE CASE STUDY REVEALED THAT THE KEY FACTOR INFLUENCING THE PROGRESS MADE AT THESE FACILITIES WAS THE AMOUNT OF SUPPORT AND COOPERATION FROM THE MEDICAL COMMUNITY. INTEREST AND ENTHUSIASM OF THE JAIL'S TOP ADMINISTRATORS COULD NOT ALONE EFFECT POSITIVE CHANGE. THE IMPACT MEASURES REVEALED POSITIVE EFFECTS OF THE AMA PROGRAM REGARDING THE EXTENT AND TYPE OF HEALTH CARE PROVIDED, AND THE ATTITUDES OF INMATES AND BOOKING OFFICERS. GRAPHS AND TABULAR DATA ARE INCLUDED. APPENDIXES CONTAIN AN ABBREVIATION FORM, A SAMPLE APPLICATION FORM FOR JAIL ACCREDITATION, SAMPLE INTERVIEWS, AND OTHER DOCUMENTS USED IN THIS STUDY.