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Injuries Account for Over Half of Children's Medicaid Expenses


Baltimore Children Have Nearly Twice the Rate of Injury as the National Average

Preventing injuries to children could not only save lives, but hundreds of thousands of dollars in Medicaid spending each year, according to researchers at the Johns Hopkins Bloomberg School of Public Health. A study of children ages six and under living in Baltimore found that the cost of injuries to these children takes up more than half of the capitated rate, which is the annual fee paid to managed care organizations to insure an individual child. The findings also show that children living in Baltimore City are injured at twice the rate of the national average. The study is the first to estimate the cost of injuries to children enrolled in Medicaid managed care organizations and is published in the July-August 2002 issue of Ambulatory Pediatrics.

“We determined that the cost of medical care for injuries to children is about $396 per covered child per year. Medicaid’s annual reimbursement to managed care organizations was about $734 for girls and $938 for boys. Between 42 and 54 percent of the reimbursement collected by managed care organizations for each child was for the cost of injuries,” says lead author David Bishai, MD, MPH, PhD, assistant professor of population and family health sciences at the Johns Hopkins Bloomberg School of Public Health. “The burden of injuries to children in managed care is higher in Medicaid populations. In Baltimore, we found that injuries to children occurred at twice the national rate,” explains Dr. Bishai.

For the study, Dr. Bishai and his colleagues examined the medical claims records of children, ages six and under, enrolled in managed care organizations at five Baltimore outpatient clinics between 1997 and 1999. The researchers analyzed the cost of each injury episode and classified the injuries as blunt/penetrating trauma, poisonings, thermal injuries, or wayward foreign body injuries. Children injured in motor vehicle accidents were excluded, because most of these injuries were covered by automobile insurance.

According to the study, the total cost of injuries during the study period was $863,552 for a sample of 1,732 children, which breaks down to $396 per covered child per year. The average medical cost per injured child in the study was $1,085. The study also found that blunt force and penetrating injuries were the most common. These injuries were most often caused by falls. Because of their frequency, the researchers say these injuries contributed the most cost, estimated to be $265 per covered child. Burns and poisonings were the most costly injury events, at $1,385 and $1,389 per injured child, respectively.

“Our findings suggest that preventing injuries to children could ease the financial burden on Medicaid and managed care organizations, as well as save lives,” explains co-author Andrea Gielen, ScD, deputy director of the Johns Hopkins Center for Injury Research and Policy and professor of health policy and management at the Johns Hopkins Bloomberg School of Public Health. “There are a number of injury control strategies managed care organizations could consider funding to reduce injuries to children, such as educating parents and caregivers about safety techniques and providing affordable safety products. Initiatives, like the Johns Hopkins Children’s Safety Center and our Mobile Safety Center are working to meet these goals, but more needs to done,” adds Dr. Gielen.

“The Burden of Injury in Preschool Children In an Urban Medicaid Managed Care Organization,” was written by David Bishai, MD, MPH, PhD, Jeanne McCauley, MD, MPH, FACP, Lara Trifiletti, MA, Eileen McDonald, MS, Brigitte Reeb, MFA, Ruth Ashman, MD, and Andrea Gielen, ScD, ScM. It is published in the July-August 2002 issue of Ambulatory Pediatrics.

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Public Affairs Media Contact for the Johns Hopkins Bloomberg School of Public Health: Tim Parsons @ 410.955.6878 or