Skip to main content
PMC home page
Public Health Reports logoLink to Public Health Reports
. 2004 Nov-Dec;119(6):557–567. doi: 10.1016/j.phr.2004.09.005

Physical partner violence and medicaid utilization and expenditures.

Ann L Coker 1, C Eugene Reeder 1, Mary Kay Fadden 1, Paige H Smith 1
PMCID: PMC1497667  PMID: 15504447

Abstract

OBJECTIVES: Little research has addressed differences in health care expenditures among women who are currently experiencing intimate partner violence (IPV) compared with those who are not. The purpose of this work is to provide estimates of direct medical expenditure for physician, drug, and hospital utilization among Medicaid-eligible women who screened as currently experiencing IPV compared with those who are not currently experiencing IPV. METHODS: In this family practice-based cross-sectional study, women were screened for current IPV using a 15-item Index of Spouse Abuse-Physical (ISA-P) between 1997 and 1998. Consents were obtained from study subjects to review Medicaid expenditure and utilization data for the same time period. RESULTS: Mean physician, hospital, and total expenditures were higher for those women with higher IPV scores compared with those who scored as not currently experiencing IPV, after adjusting for confounders. Higher IPV scores were associated with a three-fold increased risk of having a total expenditure over $5,000 (95% confidence interval [CI] 1.3, 8.4). The mean total expenditure difference between the high IPV and no IPV groups was $1,064 (95% CI $623, $1506). The adjusted risk ratio for high IPV score and the log of total Medicaid expenditures was 2.3 (95% CI 1.2, 4.4). CONCLUSIONS: Women screened as experiencing higher IPV scores had higher Medicaid expenditures compared with women not currently experiencing IPV. Early IPV assessment partnered with effective clinic or community-based interventions may help to identify IPV earlier and reduce the health impact and cost of IPV.

Full Text

The Full Text of this article is available as a PDF (117.8 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Abbott J., Johnson R., Koziol-McLain J., Lowenstein S. R. Domestic violence against women. Incidence and prevalence in an emergency department population. JAMA. 1995 Jun 14;273(22):1763–1767. doi: 10.1001/jama.273.22.1763. [DOI] [PubMed] [Google Scholar]
  2. Bergman B., Brismar B., Nordin C. Utilisation of medical care by abused women. BMJ. 1992 Jul 4;305(6844):27–28. doi: 10.1136/bmj.305.6844.27. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Bullock L., McFarlane J., Bateman L. H., Miller V. The prevalence and characteristics of battered women in a primary care setting. Nurse Pract. 1989 Jun;14(6):47, 50, 53-6. [PubMed] [Google Scholar]
  4. Campbell J. C., Lewandowski L. A. Mental and physical health effects of intimate partner violence on women and children. Psychiatr Clin North Am. 1997 Jun;20(2):353–374. doi: 10.1016/s0193-953x(05)70317-8. [DOI] [PubMed] [Google Scholar]
  5. Cascardi M., Langhinrichsen J., Vivian D. Marital aggression. Impact, injury, and health correlates for husbands and wives. Arch Intern Med. 1992 Jun;152(6):1178–1184. doi: 10.1001/archinte.152.6.1178. [DOI] [PubMed] [Google Scholar]
  6. Coker A. L., Smith P. H., Bethea L., King M. R., McKeown R. E. Physical health consequences of physical and psychological intimate partner violence. Arch Fam Med. 2000 May;9(5):451–457. doi: 10.1001/archfami.9.5.451. [DOI] [PubMed] [Google Scholar]
  7. Coker A. L., Smith P. H., McKeown R. E., King M. J. Frequency and correlates of intimate partner violence by type: physical, sexual, and psychological battering. Am J Public Health. 2000 Apr;90(4):553–559. doi: 10.2105/ajph.90.4.553. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Coker Ann L., Bethea Lesa, Smith Paige H., Fadden Mary Kay, Brandt Heather M. Missed opportunities: intimate partner violence in family practice settings. Prev Med. 2002 Apr;34(4):445–454. doi: 10.1006/pmed.2001.1005. [DOI] [PubMed] [Google Scholar]
  9. Coker Ann L., Davis Keith E., Arias Ileana, Desai Sujata, Sanderson Maureen, Brandt Heather M., Smith Paige H. Physical and mental health effects of intimate partner violence for men and women. Am J Prev Med. 2002 Nov;23(4):260–268. doi: 10.1016/s0749-3797(02)00514-7. [DOI] [PubMed] [Google Scholar]
  10. Freund K. M., Bak S. M., Blackhall L. Identifying domestic violence in primary care practice. J Gen Intern Med. 1996 Jan;11(1):44–46. doi: 10.1007/BF02603485. [DOI] [PubMed] [Google Scholar]
  11. Gin N. E., Rucker L., Frayne S., Cygan R., Hubbell F. A. Prevalence of domestic violence among patients in three ambulatory care internal medicine clinics. J Gen Intern Med. 1991 Jul-Aug;6(4):317–322. doi: 10.1007/BF02597429. [DOI] [PubMed] [Google Scholar]
  12. Hathaway J. E., Mucci L. A., Silverman J. G., Brooks D. R., Mathews R., Pavlos C. A. Health status and health care use of Massachusetts women reporting partner abuse. Am J Prev Med. 2000 Nov;19(4):302–307. doi: 10.1016/s0749-3797(00)00236-1. [DOI] [PubMed] [Google Scholar]
  13. Kernic M. A., Wolf M. E., Holt V. L. Rates and relative risk of hospital admission among women in violent intimate partner relationships. Am J Public Health. 2000 Sep;90(9):1416–1420. doi: 10.2105/ajph.90.9.1416. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Koss M. P., Heslet L. Somatic consequences of violence against women. Arch Fam Med. 1992 Sep;1(1):53–59. doi: 10.1001/archfami.1.1.53. [DOI] [PubMed] [Google Scholar]
  15. Kurz D. Separation, divorce, and woman abuse. Violence Against Women. 1996 Mar;2(1):63–81. doi: 10.1177/1077801296002001004. [DOI] [PubMed] [Google Scholar]
  16. McLeer S. V., Anwar R. A study of battered women presenting in an emergency department. Am J Public Health. 1989 Jan;79(1):65–66. doi: 10.2105/ajph.79.1.65. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Plichta S. B., Abraham C. Violence and gynecologic health in women <50 years old. Am J Obstet Gynecol. 1996 Mar;174(3):903–907. doi: 10.1016/s0002-9378(96)70323-x. [DOI] [PubMed] [Google Scholar]
  18. Plichta S. The effects of woman abuse on health care utilization and health status: a literature review. Womens Health Issues. 1992 Fall;2(3):154–163. doi: 10.1016/s1049-3867(05)80264-6. [DOI] [PubMed] [Google Scholar]
  19. Rath G. D., Jarratt L. G., Leonardson G. Rates of domestic violence against adult women by men partners. J Am Board Fam Pract. 1989 Oct-Dec;2(4):227–233. [PubMed] [Google Scholar]
  20. Russell M., Bigler L. Screening for alcohol-related problems in an outpatient obstetric-gynecologic clinic. Am J Obstet Gynecol. 1979 May 1;134(1):4–12. doi: 10.1016/0002-9378(79)90787-7. [DOI] [PubMed] [Google Scholar]
  21. Sansone R. A., Wiederman M. W., Sansone L. A. Health care utilization and history of trauma among women in a primary care setting. Violence Vict. 1997 Summer;12(2):165–172. [PubMed] [Google Scholar]
  22. Skinner H. A. The drug abuse screening test. Addict Behav. 1982;7(4):363–371. doi: 10.1016/0306-4603(82)90005-3. [DOI] [PubMed] [Google Scholar]
  23. Smith P. H., Gittelman D. K. Psychological consequences of battering. Implications for women's health and medical practice. N C Med J. 1994 Sep;55(9):434–439. [PubMed] [Google Scholar]
  24. Smith P. H., Tessaro I., Earp J. A. Women's experiences with battering: a conceptualization from qualitative research. Womens Health Issues. 1995 Winter;5(4):173–182. doi: 10.1016/1049-3867(95)00615-X. [DOI] [PubMed] [Google Scholar]
  25. Straus M. A. Medical care costs of intrafamily assault and homicide. Bull N Y Acad Med. 1986 Jun;62(5):556–561. [PMC free article] [PubMed] [Google Scholar]
  26. Ulrich Yvonne C., Cain Kevin C., Sugg Nancy K., Rivara Frederick P., Rubanowice David M., Thompson Robert S. Medical care utilization patterns in women with diagnosed domestic violence. Am J Prev Med. 2003 Jan;24(1):9–15. doi: 10.1016/s0749-3797(02)00577-9. [DOI] [PubMed] [Google Scholar]
  27. Wisner C. L., Gilmer T. P., Saltzman L. E., Zink T. M. Intimate partner violence against women: do victims cost health plans more? J Fam Pract. 1999 Jun;48(6):439–443. [PubMed] [Google Scholar]

Articles from Public Health Reports are provided here courtesy of SAGE Publications

RESOURCES