SEATTLE -- Women with a history of abuse by intimate partners have significantly higher health care costs and utilization than women with no history of such abuse, according to a study conducted at Group Health, a Seattle-based health plan. The higher costs and utilization continued long after the abuse ended, the research team from Group Health, the University of Washington (UW), and the Harborview Injury Prevention and Research Center (HIPRC) found. The findings appear in the February 2007 issue of the American Journal of Preventive Medicine.
"These results show the enormous costs of intimate partner violence (IPV) and can justify investing in intervention programs to reduce its health effects and prevent its recurrence, said lead author Frederick P. Rivara, MD, MPH. "It would also justify the costs of long-term programs to prevent this problem from happening in the first place."
Rivara is a researcher with HIPRC and professor of pediatrics at UW, as well as an affiliate investigator at the Group Health Center for Health Studies. The principal investigator for the study is Robert S. Thompson, MD, senior investigator at Group Health Center for Health Studies.
The study was based on telephone surveys, medical records, and utilization data from 3,333 women, aged 18 to 64 years old. Of these, 1,546 women reported having experienced IPV in their lifetime. The study defines IPV as both physical abuse (slapping, hitting, kicking, or forced sex) and nonphysical abuse (threats, chronic disparaging remarks, or controlling behavior).
The study showed:
- Annual total health care costs were 19 percent higher in women with a history of IPV ($439 annually) compared to women without IPV in their backgrounds.
- Health care utilization was higher for all categories of service during and after IPV compared to women who had not been abused. Women reporting IPV had 17 percent more primary care visits; 14 percent more specialist visits; and 27 percent more prescription refills. They were also more likely to use services in the areas of mental health, substance abuse, hospital outpatient care, emergency department care, and acute inpatient care during and after periods of IPV.
- Health care utilization was still 20 percent higher five years after women's abuse ceased compared to women who had never experienced IPV.
- The estimated excess costs to the health plan due to IPV are approximately $19.3 million per year for every 100,000 women enrollees aged 18¬-64. This estimate is based on prevalence for IPV of 44 percent--a figure established in a study the Group Health/UW team published in 2005.
While previous studies have shown increased health care costs and utilization among women abused by their partners, this is the first study to determine how those factors relate to the time of abuse. The study avoided limitations of previous studies by analyzing a random sample from a large health plan that was representative of the community. In addition, the researchers studied documented medical and cost records rather than relying solely the women's own reports. Also, the study had data on the women's care over an average of seven years.
"When coupled with our previous work, this study helps to complete the picture of IPV as it is encountered in health care delivery," says Thompson, whose research team published papers in 2006 on the prevalence and health effects of IPV. "IPV is common, chronic, and produces negative effects on women's physical and mental health that are as severe as cancer or diabetes, and that add an enormous economic burden to health care systems. Development, implementation and evaluations of systems for the secondary prevention of IPV are not only warranted, they are urgently needed."
The research was funded as part of a four-year, $2.4 million grant to Group Health Center for Health Studies from the Agency for Healthcare Research and Quality.
In addition to Rivara and Thompson, study co-authors are Melissa L. Anderson, MS, Paul Fishman, PhD, Amy E. Bonomi, PhD, MPH, Robert J. Reid, MD, PhD, David Carrell, PhD, all of Group Health Center for Health Studies.