The records “show that the abused or neglected children, regardless
of type of abuse, had significantly higher average charges,” say
Sue Rovi, Ph.D., Ping-Hsin Chen, Ph.D., and Mark S. Johnson, M.D., M.P.H.,
of the New Jersey Medical School of the University of Medicine and Dentistry
of New Jersey. Their research appears in the American Journal of
Public Health.
They put the average difference at $10,000 for the estimated 4,771 children
hospitalized for abuse or neglect. Of those children, an estimated 190
died of their injuries.
This study looked at those children whose diagnoses were
recorded in a hospital, and the authors say the results “provide
the economic rationale for policies and programs to prevent child abuse
and neglect.”
Child abuse is under-identified and under-diagnosed, they say. Intervening
on behalf of these children, or those in danger of being abused or neglected,
might not only help the children but would also save medical and social
costs. Better training for medical personnel would help them recognize
and correctly diagnose abuse and neglect.
The researchers used data from the 1999 Healthcare Costs
and Utilization Project’s nationwide sample of hospitalized patients
in 984 hospitals in 24 states, including 636,802 children more than a
day old. This annual
sample is sponsored by the Agency for Healthcare Research and Quality.
Physical abuse was the most common abuse diagnosis, followed by shaken
infant syndrome, child neglect and sexual abuse.
Teaching hospitals found three times more cases of abuse than other institutions,
perhaps reflecting better medical training and awareness.
Children with abuse or neglect in their medical records had twice the
number of diagnoses, spent more than twice the time in the hospital (8.2
vs. 4.0 days), and incurred more than double the costs compared with other
children, Rovi says. Their average bill came to $19,266, compared to $9,513
for other children.
However, the researchers say, those figures underestimate
the true cost, since they reflect hospitalization charges but not physician’s
services or later medical care.
“Our estimate of the charges for one hospitalized victim of abuse
or neglect does not reflect the lifetime of health care costs that can
result in such cases,” Rovi says. “We know that abused and
neglected children often experience poorer mental and physical health,
requiring more medical and social services.”
Hospitalized children who were abused were younger than other children,
averaging 2.7 years old compared to 5.2 years for the others. Black children
and those unclassified by race were disproportionately more likely to have
abuse or neglect noted in their records than white children.
“It is possible that more ‘vulnerable’ groups may be
more likely to be diagnosed, coded, or reported as abused or neglected,” Rovi
says. “More research is needed to clarify this point.”
Only 24 percent of the abused or neglected children were covered by private
insurers, while 67 percent were covered by Medicaid. Other researchers
have said that lower incomes are related to higher levels of maltreatment,
Rovi says, but not racial differences.
The Department of Family Medicine at the University of Medicine and Dentistry
of New Jersey, New Jersey Medical School in Newark provided funding for
this study.
