BACKGROUND: Child maltreatment is associated with physical and mental health problems. The objective of this study was to compare Medicaid expenditures based on a first-time finding of child maltreatment by Child Protective Services (CPS). METHODS: This retrospective cohort study included children aged 0 to 14 years enrolled in Utah Medicaid between January 2007 and December 2009. The exposed group included children enrolled in Medicaid during the month of a first-time CPS finding of maltreatment not resulting in out-of-home placement. The unexposed group included children enrolled in Medicaid in the same months without CPS involvement. Quantile regression was used to describe differences in average nonpharmacy Medicaid expenditures per child-year associated with a first-time CPS finding of maltreatment. RESULTS: A total of 6593 exposed children and 39 181 unexposed children contributed 20 670 and 105 982 child-years to this analysis, respectively. In adjusted quantile regression, exposed children at the 50th percentile of health care spending had annual expenditures $78 (95% confidence interval [CI], 65 to 90) higher than unexposed children. This difference increased to $336 (95% CI, 283 to 389) and $1038 (95% CI, 812 to 1264) at the 75th and 90th percentiles of health care spending. Differences were higher among older children, children with mental health diagnoses, and children with repeated episodes of CPS involvement; differences were lower among children with severe chronic health conditions. CONCLUSIONS: Maltreatment is associated with increased health care expenditures, but these costs are not evenly distributed. Better understanding of the reasons for and outcomes associated with differences in health care costs for children with a history of maltreatment is needed.
BACKGROUND:Child maltreatment is associated with physical and mental health problems. The objective of this study was to compare Medicaid expenditures based on a first-time finding of child maltreatment by Child Protective Services (CPS). METHODS: This retrospective cohort study included children aged 0 to 14 years enrolled in Utah Medicaid between January 2007 and December 2009. The exposed group included children enrolled in Medicaid during the month of a first-time CPS finding of maltreatment not resulting in out-of-home placement. The unexposed group included children enrolled in Medicaid in the same months without CPS involvement. Quantile regression was used to describe differences in average nonpharmacy Medicaid expenditures per child-year associated with a first-time CPS finding of maltreatment. RESULTS: A total of 6593 exposed children and 39 181 unexposed children contributed 20 670 and 105 982 child-years to this analysis, respectively. In adjusted quantile regression, exposed children at the 50th percentile of health care spending had annual expenditures $78 (95% confidence interval [CI], 65 to 90) higher than unexposed children. This difference increased to $336 (95% CI, 283 to 389) and $1038 (95% CI, 812 to 1264) at the 75th and 90th percentiles of health care spending. Differences were higher among older children, children with mental health diagnoses, and children with repeated episodes of CPS involvement; differences were lower among children with severe chronic health conditions. CONCLUSIONS: Maltreatment is associated with increased health care expenditures, but these costs are not evenly distributed. Better understanding of the reasons for and outcomes associated with differences in health care costs for children with a history of maltreatment is needed.
Authors: Ricardo A Mosquera; Elenir B C Avritscher; Cheryl L Samuels; Tomika S Harris; Claudia Pedroza; Patricia Evans; Fernando Navarro; Susan H Wootton; Susan Pacheco; Guy Clifton; Shade Moody; Luisa Franzini; John Zupancic; Jon E Tyson Journal: JAMA Date: 2014 Dec 24-31 Impact factor: 56.272
Authors: Jay G Berry; Matt Hall; John Neff; Denise Goodman; Eyal Cohen; Rishi Agrawal; Dennis Kuo; Chris Feudtner Journal: Health Aff (Millwood) Date: 2014-12 Impact factor: 6.301
Authors: Amy E Bonomi; Melissa L Anderson; Frederick P Rivara; Elizabeth A Cannon; Paul A Fishman; David Carrell; Robert J Reid; Robert S Thompson Journal: J Gen Intern Med Date: 2008-01-19 Impact factor: 5.128
Authors: Dennis Z Kuo; Matt Hall; Rishi Agrawal; Eyal Cohen; Chris Feudtner; Denise M Goodman; John M Neff; Jay G Berry Journal: Pediatrics Date: 2015-11-16 Impact factor: 7.124
Authors: David M Rubin; Evaline A Alessandrini; Chris Feudtner; David S Mandell; A Russell Localio; Trevor Hadley Journal: Pediatrics Date: 2004-05 Impact factor: 7.124