This paper presents new estimates of the average lifetime cost per child maltreatment (CM) victim in the United States and aggregate lifetime costs for all new cases of CM incurred in 2008 using an incidence-based approach. This study extends previous research in this area by correcting methodological flaws of previous studies; incorporating more recent and comprehensive studies of the epidemiology, consequences, and costs of CM; and providing a framework for using the findings in the literature to estimate the incidence-based economic burden of CM.
Child maltreatment is a serious and prevalent public health problem in the United States, responsible for substantial morbidity and mortality. In 2008, US state and local child protective services (CPS) received 3.3 million reports of children being abused or neglected and an estimated 772,000 children were classified by CPS authorities as being maltreated. Three-quarters of victims (75%) had no history of prior victimization. Although the number of confirmed cases has decreased over the past several years, researchers argue that CPS data grossly underestimate the total incidence of CM A nationally representative study of children aged 0–17 reported that 10.2% of US children experienced some form of maltreatment in 2008.
CM has been shown to have lifelong adverse health, social, and economic consequences for survivors. Given the high prevalence of CM and the many negative short- and long-term consequences of CM, the economic costs of CM may be substantial. Estimating the economic burden of CM is important for several reasons. Economic estimates can help to increase awareness of the current severity of CM, place the problem in the context of other public health concerns, and may be used in economic evaluation of interventions to reduce or prevent CM. Using the median age for CM victims in 2008 which is 6 years old, the authors calculated the average lifetime cost per victim, which was defined as the sum of short-term health care costs, long-term health care costs, productivity losses, child welfare costs, criminal justice costs, and special education costs. In other words, the present value of all future costs is estimated starting at age 6. For each category, attributable costs was used whenever possible (e.g., health care costs).
Using an incidence-based approach, the lifetime economic burden of CM resulting from an estimated 579,000 new cases of nonfatal CM and 1,740 cases of fatal CM that occurred in the United States in 2008 is approximately $124 billion. On average, the lifetime cost is estimated to be $210,012 per victim of nonfatal CM and $1,272,900 per victim of fatal CM. Comparing these costs to that of other high profile public health problems, such as lifetime costs of stroke per person ($159,846) or the total lifetime costs associated with type 2 diabetes (between $181,000 and $253,000 per case, the authors argue that CM costs and prevalence are high enough for policy makers to justify allocating resources to effective prevention and mitigation strategies for CM. Although the evidence base for effective strategies to address CM is limited, the authors suggests that a promising array of prevention and response programs have great potential to reduce the substantial economic burden of CM and that the benefits of prevention will likely outweigh the costs for effective programs.
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