(Table 2-4). One comprehensive model for estimating the annual cost of domestic violence includes direct costs, such as health care costs, social service costs, and criminal justice costs, as well as indirect costs, such as morbidity and mortality costs, which measure lost output when a victim is incapacitated or killed (Rice et al., 1996). Several assumptions are implicit in the model: that direct cost components can be estimated with available data on charges and expenditures for goods and services; that a discount rate of 4 percent and an average annual increase in productivity of 1 percent are appropriate in generating future costs, and that certain other costs of health and social services, such as moral support and advocacy for victims, should be excluded. The costs of these may be significant, but no reliable data exist from which to estimate them.

A cost estimate for child maltreatment for the year 1983 was developed by calculating the number of child abuse reports received, what percentage were substantiated, and what percentage actually received various types of services, including foster care (Daro, 1988). It estimated that the immediate cost of hospitalizing abused and neglected children was $20 million annually, rehabilitation and special education cost $7 million annually, and foster care costs were $460 million annually. Additional short-term costs include education, juvenile court and detention costs, $646 million for long-term foster care, and future lost earnings of abused and neglected children of between $658 and $1.3 billion.

Extrapolating Daro's costs for 1994, Westman (1995) included estimates for hospitalization, rehabilitation and special education, foster care, social services case management, and court expenses. His cost estimate was between $8.4 and $32.3 billion each year, based on a range of $12,174 to $46,870 per maltreated child per year.

Miller et al. (1994) estimate that personal crime costs Americans $105 billion each year. Including pain and suffering, the cost rises to $450 billion. Violent crime accounts for $426 billion of the total. The authors estimate that child abuse costs $67,000 per incident, sexual abuse $99,000, and emotional abuse $27,000 for an average of $60,000 per incident of child abuse. The authors estimated that child neglect costs $9,700 per incident. Thus, the total cost of child abuse and neglect per year is estimated to be $56 billion. Miller et al. (1994) do not include in their estimate the cost for sibling violence, noncriminal violence toward parents, or noncriminal elder abuse. Thus, their cost estimate of $77 billion for child abuse and domestic violence still underestimates the total costs of family violence each year.

What is also unknown in reviewing these cost estimates is the extent to which existing expenses associated with health, social services, and legal services could be reduced if effective preventive interventions were in place. Reducing the scope of family violence and mitigating its consequences would have some impact on existing service expenses, most of which are borne by individuals or public agencies, but the size of that impact remains uncertain.

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