Intimate partner violence leads to a lifetime of increased health costs

Author: Jananie William^1, Bronwyn Loong¹, Dana Hanna², Bonny Parkinson^{3, 4}, Deborah Loxton⁵

1. Research School of Finance, Actuarial Studies and Statistics, College of Business and Economics, Australian National University, Acton, ACT, Australia.
2. Research School of Economics, College of Business and Economics, Australian National University, Acton, ACT, Australia.
3. Macquarie University Centre for the Health Economy, Macquarie University, Australia.
4. Australian Institute of Health Innovation, Macquarie University, NSW, Australia.
5. Centre for Women’s Health Research, The University of Newcastle, University Drive, Callaghan, NSW, Australia.

Intimate partner violence (IPV) is a pervasive global health problem experienced by approximately 30% of women worldwide and has devastating impacts on the lives of affected women. Some health effects of IPV are immediate, such as short-term physical injuries and death. However, other health effects are less obvious but significant. They may develop years after the IPV began and persist after it has ceased, including increased rates of chronic conditions, physical disabilities, sexually transmitted diseases, poor reproductive outcomes, self-harm, alcohol disorders, and mental health conditions.

The relationship between IPV and health costs is complex. The characteristics of women who experience violence (such as socioeconomic factors and childhood adversity) may be associated with both IPV and poor health or increased health costs, making the strength of the relationship seem stronger than reality. Some health conditions and increased financial stress (potentially owing to increased health costs) may also increase the risk of experiencing IPV, which introduces reverse causality. Women may also under-report experiencing IPV due to personal (e.g. embarrassment or fear) or societal (e.g. culture or stigma) reasons or not realising they have experienced IPV.

This study quantified the excess lifetime out-of-hospital and pharmaceutical health costs of women who experience IPV in Australia. A multidisciplinary team from the Australian National University, Macquarie University and the University of Newcastle applied a novel combination of econometric and actuarial techniques to a large and unique dataset, that is, the Australian Longitudinal Study of Women’s Health (ALSWH) linked to administrative national health insurance data from 1996 to 2018 (Medicare and the Pharmaceutical Benefits Scheme, PBS). The approach enabled the robust estimation of whether IPV leads to increased health costs both in the past (1996 to 2018) and projected over a lifetime (after 2018), accounting for the complexity of the relationship.

The study found that women who had experienced IPV had 42% (Medicare) and 44% (PBS) higher health costs over their lifetime compared with women who did not experience IPV. This equated to AU$48,413 (2020) per person, of which approximately 89% of costs were projected to incurred after 2018. Despite the lower life expectancy of women who experienced IPV, their mean lifetime costs were still higher than the 95th percentile of women who did not experience IPV. Furthermore, the study found that the adverse health impact of IPV leads to increased health costs over one’s lifetime, regardless of whether the initial IPV experience was early or later in life.

The results provide further evidence of the resource and cost burden on the health system owing to IPV but highlight explicitly the significant impact it can have over the lifetime. The results suggest that investment in primary prevention and early intervention will have long-term effects on the healthcare system and reduce health costs. Moreover, long-term IPV recovery support is needed, given the persistent and ongoing impacts of IPV.