The information presented below summarizes existing data from the Centers for Disease Control and Prevention’s National Center for Injury Prevention and Control (CDC Injury Center) on the cost impact of injuries among Centers for Medicaid and Medicare Services (CMS) populations. The mission of the CDC Injury Center is to prevent injuries and violence, and reduce their consequences. NCIPC’s research includes looking at existing medical costs for injuries and violence and estimating future medical cost savings achievable through the implementation of evidence-based interventions.
Older Adult Falls
CMS Population Affected: The U.S. population is aging rapidly. Currently, 35 million Americans are 65 years of age or older, and by 2020 this number is expected to reach 77 million. The majority of adults over age 64 are covered under the Medicare federal health insurance program.In 2005, about 22% of community-dwelling Medicare beneficiaries reported falling in the previous year[i]. These fall injuries accounted for 17% of emergency department visits and 8% of hospital admissions. About one quarter of fall injuries were fractures; 4% were hip fractures[ii] .Fall injuries are one of the 20 most expensive medical conditions. Adjusted for inflation, direct medical costs of older adult fall injuries in 2011 totaled $36.4 billion[iii]. Medicare costs in the first year after a fall averaged between $12,150 and $18,009. About 58% of direct medical costs were for inpatient hospitalizations, 16% for home health care, 10% for medical office visits, 8% for hospital outpatient visits, 6% for emergency room visits, and 1% each for prescription drugs and dental visits. Of these costs, about 78% were reimbursed by Medicareii. In 2011 dollars adjusted for inflation, the annual cost of falls in 2020 will be approximately $61.6 billion[iv].
Prescription Drug Overdose
CMS Population Affected: Poor and rural populations are overall more likely to experience prescription overdoses[v],[vi]. In Washington State, for example, from 2004 to 2007, 1,668 people died of prescription opioid-related overdoses. Of those, 45.4% percent were Medicaid enrolled, and this population had a 5.7 fold increased risk of prescription opioid-related overdose death[vii].Adoption of lock-in programs can produce significant cost benefits as in Florida, where its Medicaid lock-in program saved the state Medicaid program $12 million in less than three years[viii]. Washington State has informally reported savings of $1.5 million per month with their program. Missouri, Hawaii, and Oklahoma have also reported some success. Medicaid programs spend well over $1 billion annually on opioid painkillers, and a 2009 GAO report found that these reimbursements are rife with fraud. A survey of five states identified 65,000 beneficiaries visiting six or more doctors to acquire prescriptions for the same controlled substances. These beneficiaries cost the programs $63 million in reimbursements for those drugs, and this number does not account for other related costs[ix].
Motorcycle Helmet Use
CMS Population Affected:It is estimated that the economic burden of injuries and deaths from motorcycle related crashes in one year totaled $12 billion[x]. Studies have also shown that a substantial proportion of costs are paid by the U.S. public due to higher insurance premiums and taxes, as well as lost tax revenue[xi], [xii],[xiii]. A study of 105 motorcyclists hospitalized at a major trauma center determined that 63% of their care was paid for by public funds, with Medicaid accounting for over half of all charges[xiv].Alcohol Misuse Screening and Brief InterventionCMS Population Affected:While alcohol misuse is prevalent across socioeconomic statuses and age groups, excessive drinking is the leading risk factor for injury in the United States and the third leading cause of preventable death, accounting for more than 75,000 deaths annually – that’s one death every 7 minutes. Additionally, 25% of the US population drinks in excess but is not addicted[xv]. Alcohol misuse is a serious and costly problem for our nation, including the Medicare and Medicaid populations.
Child MaltreatmentCMS Population Affected: The total lifetime estimated financial costs associated with just one year of confirmed cases of child maltreatment (physical abuse, sexual abuse, psychological abuse and neglect) is approximately $124 billion[xvi].
Each death due to child maltreatment has a lifetime cost of about $1.3 million, almost all of it in money that the child would have earned over a lifetime if he or she had lived. The short term Medicaid health care costs for victims of nonfatal child maltreatment is $32,648 and the lifetime cost for each victim of child maltreatment who lives is $210,012, which is comparable to other costly health conditions such as stroke with a lifetime cost per person estimated at $159,846 or type 2 diabetes, which is estimated between $181,000 and $253,000xvi.Safe States Alliance
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References
[i]Stevens JA, Ballesteros MF, Mack KA, et al. Gender differences in seeking care for falls in the aged Medicare population. Am J Prev Med 2012;59-62.
[ii] Carroll NV, Slattum PW, Cox FM. The cost of falls among the community-dwelling elderly.Journal of Managed Care Pharmacy. 2005;11(4):307-16.
[iii]Stevens JA, Corso PS, Finkelstein EA, Miller TR. Cost of fatal and nonfatal falls among older adults.InjPrev 2006;12(5):290–95.
[iv]Englander F, Hodson TJ, Terregrossa RA. Economic dimensions of slip and fall injuries. Journal of Forensic Science 1996;41(5):733–46.trial. The Gerontologist 1994;34(1):16–23.
[v]CDC. Overdose deaths involving prescription opioids among Medicaid enrollees-Washington, 2004-2007.MMWR. 2010;59;705-9.
[vi] Braden JB, Fan MY, Edlund MJ, Martin BC, DeVries A, Sullivan MD. Trends in use of opioids by noncancer pain type 2000-2005 among Arkansas Medicaid and HealthCore enrollees: results from the TROUP study. J Pain 2008;9(11):1026-1035.
[vii] CDC. Overdose deaths involving prescription opioids among Medicaid enrollees-Washington, 2004-2007.MMWR. 2010;59;705-9.
[viii]Florida Medicaid. Medicaid Prescribed Drug Spending Control Program Initiatives: Quarterly Report January 1- March 31, 2005. Available at URL:
[ix]GAO. Fraud and abuse related to controlled substances identified in selected states. Sept. 2009. Available at URL:
[x] Naumann RB, Dellinger AM, Zaloshnja E, Lawrence BA, Miller TR. Incidence and total lifetime costs of motor vehicle-related fatal and nonfatal injury by road user type, United States, 2005. Traffic Inj Prev. 2010;11(4):353-360.
[xi]Derrick AJ, Faucher LD. Motorcycle helmets and rider safety: A legislative crisis. J Public Health Pol. 2009;30(2):226-242.
[xii] Hundley JC, Kilgo PD, Miller PR, Chang MC, Hensberry RA, Meredith JW, Hoth JJ. Non-helmeted motorcyclists: A burden to society? A study using the national trauma data bank.J Trauma. 2004;57(5):944–949.
[xiii]Rivara FP, Dicker BG, Bergman AB, Dacey R, Herman C. The public cost of motorcycle trauma. JAMA. 1988;260(2):221-223.
[xiv]Rivara FP, Dicker BG, Bergman AB, Dacey R, Herman C. The public cost of motorcycle trauma. JAMA. 1988;260(2):221-223.
[xv]Higgins-Biddle J, Hungerford D, Cates-Wessel K. Screening and Brief Interventions (SBI) for Unhealthy Alcohol Use: A Step-By-Step Implementation Guide for Trauma Centers. Atlanta (GA): Centers for Disease Control and Prevention, National Center for Injury Prevention and Control; 2009.
[xvi]Xiangming F, Brown D, Florence C, Mercy J. The economic burden of child maltreatment in the US an implications for prevention Child Abuse and Neglect,2012;36(2):156-165.