Hospital charges for abused or neglected children are twice the average of other children

Hospital charges for abused or neglected children are twice the average of other children, and a child diagnosed at the hospital with abuse or neglect is nearly nine times more likely to die, according to a new analysis of records of more than half a million children.


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.


Health Behavior News Service: (202) 387-2829 or hbns.

Interviews: Contact Sue L.D. Rovi at (973) 972-2497, or RoviSLumdnj.

American Journal of Public Health: (202) 777-2511 or ajph.


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