Financial burden of hospitalisation for child abuse in Hong Kong

Abstract

Child abuse is a well-known child care problem. Classically, there are four main types of abuse: physical, sexual and emotional abuse, and neglect. The incidence is often underestimated because a number of cases are not severe enough for caregivers to seek medical help. However, the more severe forms of child abuse can lead to significant morbidity and even mortality. Many studies have addressed the characteristics and outcomes of child abuse. However, the financial burden of child abuse that individuals and society bear has not been well examined.

In this study, the economic burden of hospitalisation for child abuse in Hong Kong is analysed. Data of 7,713 child hospitalisations and of 61,879 child visits to accident and emergency departments of public hospitals, all resulting from child abuse from 2003 to 2012, were retrieved from the Clinical Data Analysis and Reporting System. The data are analysed with particular respect to cost of child abuse.

The total inpatient cost of child abuse is HK$186,046,210, which is higher than the total inpatient cost of children with acute lymphoblastic leukaemia (HK$171,895,920) but lower than that of children with asthma (HK$1,156,082,970). The average inpatient cost of child abuse per visit is HK$24,127, which is higher than the average inpatient cost of children with asthma (HK$14,458) but lower than the cost of children with acute lymphoblastic leukaemia (HK$39,165). In comparisons of the average inpatient costs of the various types of child abuse to those of asthma and acute lymphoblastic leukaemia, each type of child abuse has higher average inpatient costs than asthma but lower than acute lymphoblastic leukaemia. Neglect produces the highest average cost (HK$33,606), followed by multiple abuse (HK$25,849) and then emotional abuse (HK$25,807), unspecified abuse (HK$25,090), physical abuse (HK$24,432) and sexual abuse (HK$17,807).

The overall accident and emergency department cost for child abuse is HK$43,394,400, which is much higher than the overall cost for children with acute lymphoblastic leukaemia (HK$1,193,500) but lower than that for children with asthma (HK$120,297,100). The mean cost for abuse per child is HK$5,784, which is higher than that per child with acute lymphoblastic leukaemia (HK$2,411) but lower than that per child with asthma (HK$6,389). Comparisons of the mean accident and emergency department costs of the various types of child abuse to asthma and acute lymphoblastic leukaemia showed that each type of child abuse has a higher mean cost than that of acute lymphoblastic leukaemia, while only neglect and emotional abuse have higher mean costs than asthma. Of the mean accident and emergency department charges for each type of child abuse, neglect has the highest average cost (HK$7,108), followed by emotional abuse (HK$6,489), and then sexual abuse (HK$5,890), multiple abuse (HK$5,851), unspecified abuse (HK$5,823) and physical abuse (HK$5,720).

The total and average costs of hospitalisation for child abuse in the Chinese population are higher than those in the non-Chinese population. Comparisons of the total cost and the average cost of hospitalisation between sexes showed that girls account for a higher total cost but lower average cost than boys. Of the three age groups of children, the 6-12 year-olds incur the highest total hospitalisation cost and the 0- to 6-year-olds had the highest mean hospitalisation cost. The costs of hospitalisations by different pay codes for child abuse, asthma, and acute lymphoblastic leukaemia are analysed.

In conclusion, compared to children with asthma, the severity of child abuse is high while the frequency of it is low. Interventions to reduce the severity of child abuse are to be considered. To compare to the other control group, the frequency of child abuse is more common and the severity of it is lower than that of children with ALL. Interventions to reduce the frequency of child abuse are in high priority compared to ALL. To the overall costs of hospitalisations for types of abuse, the financial burden of overall inpatient cost of physical abuse is high while financial burden of inpatient cost of individual cases of it is just average. Hence the frequency of physical abuse is high but its severity is low. Meanwhile, the financial burden per inpatient case of neglect is high while the total financial burden of hospitalisations for neglect is low. Hence the severity of neglect is high but its frequency is low. The data in this study could be used to further analyse the cost of child abuse, including non-medical costs and indirect costs, and for cost-effectiveness analysis.