Medical and mental health costs of child abuse and neglect among children and adolescents

Background: Child maltreatment is a serious public health problem, responsible for substantial morbidity and mortality. While the health and mental health impacts of child maltreatment are well documented, little economic data exists. Our study provides a rigorous estimate of the total health care impacts of child maltreatment for children and adolescents in Medicaid.

 Objective: To estimate the increased Medicaid expenditures associated with child maltreatment.

 Method: Data on child maltreatment from the National Survey of Child and Adolescent Well-Being (NSCAW I), a nationally representative sample of cases investigated or assessed by local child protective services agencies (both foster care and in-home placement) was linked to Medicaid claims data in 36 states, the full NSCAW population.  2000 to 2003 Medicaid Analytic Extract (MAX) data were used to match the NSCAW I sampling frame. Propensity score matching was used to select a comparison group from the MAX data.  Two-part regression models and a generalized linear model (GLM) were used to estimate the impact of child maltreatment on expenditures.

 Results: Children who were identified as maltreated or as being at risk for maltreatment incurred, on average, Medicaid expenditures that are over $2,800 higher per year than for children not so identified.  Mental health care and prescription drugs were particularly large components of the attributable burden.

 Conclusions: Child maltreatment imposes a substantial financial burden on the Medicaid system, as large or greater than many other serious public health problems. These data may be used in future economic evaluations of prevention and of resource allocation.