Health care costs associated with child maltreatment: impact on medicaid.

OBJECTIVE: To estimate the increased Medicaid expenditures associated with child maltreatment. METHODS: Data on child maltreatment were collected from the National Survey of Child and Adolescent Well-Being, a nationally representative sample of cases investigated or assessed by local Child Protective Services agencies between October 1999 and December 2000. Medicaid claims data for 2000 to 2003 were obtained from the Medicaid Analytic Extract (MAX). Children from the National Survey of Child and Adolescent Well-Being who had Medicaid were matched to the MAX data by Social Security number or birthdate, gender, and zip code. Propensity score matching was used to select a comparison group from the MAX data. Two-part regression models were used to estimate the impact of child maltreatment on expenditures. Data with individual identifiers were obtained under confidentiality agreements with the collecting agencies. RESULTS: Children who were identified as maltreated or as being at risk of maltreatment incurred, on average, Medicaid expenditures that were >$2600 higher per year compared with children not so identified. This finding accounted for ~9% of all Medicaid expenditures for children. CONCLUSIONS: Child maltreatment imposes a substantial financial burden on the Medicaid system. These expenses could be partially offset by increased investment in child maltreatment prevention.

The economic implications of influenza vaccination for adults with asthma.

BACKGROUND: Influenza vaccination is recommended for adults with asthma. PURPOSE: This study estimates the effect of influenza vaccination on utilization of medical services and expenditures for acute and chronic respiratory conditions (ACRC) among adults with asthma. METHODS: The sample was adults aged ≥18 years self-reporting asthma in the 2003 through 2006 Medical Expenditure Panel Survey (MEPS), covering four complete influenza seasons. The dependent variables were indicators for any ACRC claims within service category and ACRC expenditures. The main independent variable was an indicator of influenza vaccination. To control for selection bias in the observational data, a nonlinear instrumental variables approach was used. The instruments were indicators for influenza in the first year of MEPS and vaccination in the year prior to MEPS. Data were analyzed in 2009. RESULTS: Adults with asthma vaccinated for influenza were 4.4 percentage points less likely to have an inpatient stay due to ACRC (95% CI = -10.8, -1.0). Influenza vaccination was associated with a $492 decrease (95% CI = -$1591, -$56) in annual ACRC nonprescription expenditures, a $224 increase (95% CI = $70, $360) in annual ACRC prescription expenditures, and a nonsignificant $216 decrease (95% CI = -$854, $248) in overall annual ACRC expenditures. CONCLUSIONS: Although there was no evidence that vaccination reduced overall ACRC expenditures, the study suggests that efforts to increase the percentage of adults with asthma who are vaccinated may bring substantial benefits in terms of reducing the prevalence and costs of hospitalization although raising prescription medication costs, possibly through improvement in compliance.