| I Couldn't Say Anything So My Body Tried To Speak For Me: The Cost of Providing Health Care Services to Women Survivors of Childhood Sexual Abuse
S. Burgess, A. M. Watkinson,
A. Elliott, W. MacDermott, M. Epstein
Survivors of childhood sexual abuse (CSA) experience a wide range of physical and psychological symptoms and are users of health care services. Health care services include medical services (such as visits to physicians, medical specialists and chiropractors), hospitalization, emergency room services and prescription drugs. This report details the financial costs of insured health care services for 12 women survivors of CSA over a 10 and 11 year period.
Purpose and Objectives
The study asked survivors to review their health care services costs for a ten, and in some cases eleven-year period; "tell their story" about the medical interventions in focus groups and in one-on-one interviews with the principal investigator; judge whether the medical system helped their healing process; identify what other services helped them in their healing journey and make recommendations about appropriate care for women survivors of CSA.
The study used a participatory action research design with twelve women survivors of child sexual abuse who self-selected to be co-researchers (CR-survivors) over a twelve-month period. Participants ranged in age from early twenties to early sixties, and represented a wide socio-demographic spectrum. Each of the 12 CR-survivors requested and obtained their 1989-1999 health records from Saskatchewan Health. The principal investigator (PI) worked with the 12 CR-survivors in focus groups and in one-on-one interviews to document their utilization of health services, to measure the costs of these health services and to record their reflections on their interaction with the health care system.
Health care service costs were analyzed and compared to appropriate benchmarks, adjusted where possible for age and gender. Qualitative data on the CR-survivor's experience with health care services and their recommendations for improvements were gathered from interviews and focus groups. The PI analyzed the information using theme and content analysis methods.
The adjusted utilization-to-benchmark ratios showed that, on average, the cost of medical services used by CR-survivors was 3.7 times the population average. The average costs of hospitalization for CR-survivors were 3.8 times the population average and 76% of the cost of hospitalization was spent on psychiatric care. The average cost of medications prescribed to the CR-survivors was 9.4 times the population average and the cost of their emergency visits was 1.5 times the population average.
The CR-survivors reported that some of the positive consequences of insured health care services included various stabilizing effects such as control of symptoms and the ability to function in society. They reported that the negative consequences of health care services included failure of health care providers to detect CSA which may have led to a diagnosis which overlooked the underlying cause, excessive use of psychotropic drugs, and continued fragmentation of various helping systems including health care, social services, and justice.
The cost comparison for community-based services was hard to measure in part because they are not publicly funded and therefore it is difficult to access the costs. But what we do know is that local estimates indicate the average cost in a Saskatoon hospital is $583.00 per day; it costs $47.00 for a half-hour with a family doctor and $72.00 for a specialist. By comparison, community-based, publicly funded counseling costs an average of $40.00 -$50.00 an hour. The estimated cost to run a fulltime (24 hrs. per day, seven days per week) holistic healing centre focused exclusively on healing from child sexual abuse with eight beds is $205.48 per bed per day.1
While existing information does not allow a reliable estimate of the proportion of the provincial health care budget attributable to unresolved CSA, we can extrapolate the provincial cost based on provincial population number. The population of Saskatchewan is approximately 1 million, half of which is female. Using Finkelhor's (1990)2 findings that as many as one in four women are victims of sexual abuse we can estimate the yearly cost to the medical system in dealing with the CSA of women to be approximately $54,837,5003.
The 12 CR-survivors who took part in this study made extensive use of conventional health care services partially because the services were insured, available, appropriate and accessible. These conventional services, while useful, require additional psycho-social (including complementary) interventions to address the survivor's need for deep, inner, sustained healing from childhood trauma.
Interventions which are targeted towards deep, authentic, inner healing, such as healing centres in the community, could have major positive human and societal consequences and result in significant reductions in costs associated with the health care, social services, and justice systems. With appropriate reallocation of resources all survivors of CSA are more likely to have access to the help they need.
Back to top of page