How insurance companies can cut costs by stopping domestic violence

Preventing domestic abuse instead of denying patient services will save health insurers hundreds of millions. 

Health insurance companies waste hundreds of billions of dollars for care that could easily be avoided. Recently CBS reports health insurers routinely use practices that deny patients needed emergency care in a futile attempt to save much less. The inhumane, and probably illegal practices, seek to deny coverage for emergency visits insurers deem more appropriate for other less expensive venues.

The problem is that laypersons do not always know the cause or extent of their medical problems. The denial of benefits can destroy a patient’s finances. This pressure inevitably discourages patients from obtaining needed and timely care. Failure to obtain treatment can escalate the costs and sometimes cost the patients their lives.

Adverse Childhood Experiences (ACE) Studies are groundbreaking medical research from the Centers for Disease Control and Prevention that demonstrate how exposure to domestic violence, child abuse, and other trauma can cause children to suffer a lifetime of health problems.  

A medical study from the Academy on Violence and Abuse estimated that the United States spends $750 billion yearly on health costs related to our tolerance of domestic violence. Child abuse adds to the health costs we all pay in the form of premiums, taxes, and higher prices on consumer goods.

The present level of cancer, heart disease, diabetes, mental illness, crime, substance abuse, suicide, and much other everyday health and social problems is directly related to society’s long tolerance of behavior now considered domestic violence and child abuse.

Most Domestic Violence and Child Abuse is Preventable

District Attorney Bill Delahunt noticed that virtually every inmate at a nearby high-security prison had a childhood history that included domestic violence and often child sexual abuse. He believed that if he could prevent domestic violence, it would reduce all crime. He became a leader in putting together a group of best practices known as the Quincy Model.  

Subsequent research and the results in Quincy confirmed Delahunt’s beliefs. A county that averaged 5 to 6 DV homicides annually enjoyed several years with no murders. Other communities like Nashville and San Diego used similar best practices to dramatically reduce DV crime.

The successful practices in Quincy included strict enforcement of criminal laws, orders of protection, probation rules, practices that made it easier for victims to leave, and coordinated community response.

Bill Delahunt noticed that some victims stopped cooperating when their abusers sought child custody. This did not derail Quincy’s success because it was a rare tactic at the time. Today it is a standard abuser tactic for the worst abusers to seek custody to regain control over their victims. The tactic has been a disaster for protective mothers, their children, and the community because courts have been slow to integrate current research and repeatedly disbelieve true reports of abuse.

We know that implementation of the practices from the Quincy Model will dramatically reduce domestic violence because they were successful in communities like Quincy, Nashville, and San Diego. Changing the family courts through the passage of the Safe Child Act would prevent the worst abusers from using custody to undermine laws designed to prevent abuse. These best practices would save hundreds of billions of dollars annually in health costs.

Conclusion

I was excited when I first saw the study that found we are spending $750 million annually on health costs related to domestic violence. I imagined the health insurance companies would want to save hundreds of millions of dollars by implementing proven best practices that dramatically reduce domestic violence. I dreamed of having powerful lobbies with solid connections to Congress and state legislatures working with us to prevent domestic violence. I could not wait to interview leaders of the industry to discuss the research about how they could save so much money by stopping domestic violence. My calls and emails to the industry lobbying association and individual companies led to a tepid response and no interviews. A friend who worked at the highest levels of the CDC tried to help me make connections but to no avail.

Dr. Vincent Felitti, the principal co-author of the ACE study, found that giving patients a chance to speak about their trauma or even just fill out a confidential questionnaire; significantly reduced the number of doctors’ visits.  He reached out to his employer, Kaiser Permanente, to suggest that promoting these discussions would improve patients’ health while saving millions of dollars. Surprisingly the company wasn’t interested.

In this context, it is outrageous that insurers would implement possibly illegal practices to discourage emergency visits as a cost-saving measure. The practice is often financially devastating to families that made a good-faith decision to seek emergency care and inevitably will cause preventable death and more severe health problems when patients are afraid to seek the treatment they need. In contrast, savings from reducing domestic violence would save far more money, and the personal and societal consequences would be highly positive.

As it is, health insurance companies have a negative image of the public. This is caused by excessive premiums, unfair denial of needed treatment, and lobbying for laws that harm the public. Participating in a campaign to prevent domestic violence and implementing best practices would benefit society while dramatically reducing their expenses. It would be a good way for insurers to improve their public image while providing a genuine service.

CBS performed a valuable public service by exposing the improper denial of payment for good-faith emergency room visits. They could do even more good by informing the public about the enormous financial and personal benefits of preventing domestic violence and child abuse.