The Costs of Child Maltreatment

Abstract

Source: Florence C, Brown DS, Fang X, et al. Heath care costs associated with child maltreatment: impact on Medicaid. Pediatrics. 2013; 132(2): 312– 318; doi: 10.1542/peds.2012-2212Researchers from multiple institutions aimed to estimate the increased Medicaid expenditures associated with child maltreatment. The investigators used 2 databases: the National Survey of Child and Adolescent Well-Being (NSCAW) and Medicaid Analytic Extract (MAX). NSCAW contains data on children who were involved with Children’s Protective Services (CPS) agencies (denoting that the child was either maltreated or at risk for maltreatment) spanning portions of 1999 and 2000. MAX data were used to construct a matched control group of children on Medicaid with no CPS involvement. Health care expenditures and types of health service utilization for children with CPS involvement (cases) and those without (controls) were compared. Analyses were adjusted to account for skewing of means (ie, a few subjects with very large expenditures) often seen in health care expenditure data.A total of 972 cases were identified, comprising 2,465 children-years; an equal number of control children were included in the analyses. The case and control groups were similar across 6 demographic variables. Case children had considerably higher total Medicaid expenditures than those in the control group; adjusted costs were >$2,600 more per child-year compared to controls. Relative to the control group, cases were nearly twice as likely to have used psychiatric services and nearly 3 times as likely to have used targeted case management. Significant differences in utilization also existed in inpatient and outpatient care and prescription drug use.The authors conclude that Medicaid-enrolled children with investigated or substantiated cases of child maltreatment have substantially higher health care costs and utilization than non-maltreated children. The authors estimate that the cost of child maltreatment-related expenditures is 9% of all Medicaid expenditures for children.Dr Anderst has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.As the government faces tightening budget constraints and seeks to control health care costs, this study adds compelling data in support of child maltreatment prevention interventions. As some studies have shown a reduction in child maltreatment when using specific prevention interventions,1,2 the potential positive impact of these interventions on both the lives of the children and families involved and on the fiscal stability of health care must be considered. The estimated financial savings detailed in this study are clearly important; however, child maltreatment prevention programs are also known to reduce costs associated with juvenile detention, productivity, special education, and case management, among other social costs. These unaccounted savings further augment societal cost savings associated with effective child maltreatment prevention. Beyond cost savings, one may also argue that there is an ethical imperative to prevent child maltreatment. Hopefully, studies such as this will embolden efforts to prevent child maltreatment and increase the funding of child maltreatment prevention, not only for the betterment of children and families, but also for the betterment of society.Children with chronic health conditions are at greater risk of child abuse (odds ratio of 1.67 in one study3). Thus, some of the increase in Medicaid costs in these children may be due to their underlying chronic conditions, not considered in the current study. Although further prospective evaluation is needed to determine the costs specifically attributable to child maltreatment, we cannot afford to wait for these studies to initiate preventive strategies against the scourge of child abuse.