Child abuse places a significant financial burden on the Medicaid system, researchers found.
On average, children who were maltreated or were at risk for maltreatment had Medicaid expenditures more than $2,600 higher annually than children who were not subject to or at risk for maltreatment, according to Curtis Florence, PhD, of the CDC National Center for Injury Prevention and Control in Atlanta.
Compared with nonmaltreated children, costs were higher for psychiatric, inpatient hospital, and outpatient and clinical care of maltreated children, Florence and colleagues wrote online in the journal Pediatrics.
Applying their results more generally, the total number of investigated cases of child maltreatment covered by Medicaid would be about 2.2 million out of 3.7 million children with investigated cases for an estimated cost of $5.9 billion per year, they said.
The authors noted that child maltreatment often manifests as physical, sexual, and emotional abuse, as well as neglect, and is common to an estimated 772,000 U.S. children. Although programs have been established to prevent child maltreatment, no prior research has looked at the fiscal toll maltreatment carries.
Data on child maltreatment was collected from the National Survey of Child and Adolescent Well-Being, a database of cases presented to local Child Protective Service agencies from October 1999 to December 2000. A sample of 5,501 children from this cohort was then matched with Medicaid claims data from 2000 to 2003.
All children in the sample were considered "at-risk" in absence of a substantiated maltreatment claim. This was based on prior research demonstrating developmental and mental health outcomes associated with maltreatment in groups with and without verified claims.
The researchers used a propensity score-matched sample of Medicaid data of 972 children as a control group, which allowed researchers to compare expenditures between groups for total expenses, psychiatric care, inpatient hospital costs, outpatient and physician care, prescription drugs, targeted case management, and home health and rehabilitation.
They cautioned that some maltreated children were possibly included in the control sample due to their inability to match low-risk or nonmaltreated children to Medicaid data.
In a comparison of the two groups, children who were maltreated or at risk for maltreatment had "considerably higher costs overall than did observationally similar children in Medicaid," the authors stated, citing a greater-than $2,600 difference per Medicaid patient per year.
"Much of this cost difference was reflected in higher psychiatric and inpatient hospitalization costs," they noted, adding that ambulatory care ($413 difference), prescription drug ($263 difference), and targeted case management costs ($269 difference) were also substantially larger.
"Although the propensity score matching controls for the effect of the observational characteristics on healthcare spending, it cannot account for the skewed distribution of healthcare expenditures," the authors wrote.
They also found that although both populations used high overall rates of Medicaid services, there was a significantly higher use of services among the maltreatment group, who were almost twice as likely to use a psychiatric service and nearly three times as likely to have received targeted case management.
The researchers concluded that their findings show both a higher cost per case as well as a higher rate of care among victimized children.
"Overall Medicaid spending for children was $68.4 billion in 2009. Our estimates imply that the excess cost to Medicaid associated with child maltreatment are [approximately] 9% of all Medicaid expenditures for children," they said.
However, they suggested that "these expenses could be partially offset by increased investment in child maltreatment prevention."
In addition to the inclusion of nonsubstantiated incidents of maltreatment in the maltreated sample, the authors noted that the study was limited by estimated Medicaid expenditure data.
The authors declared no conflicts of interest.
- Reviewed by Robert Jasmer, MD Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner