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Databook on Nonfatal Injury: Incidence, Costs and Consequences.

If you like numbers, enjoy data collection quagmires, and have a related interest in morbidity, then the Databook on Nonfatal Injury is for you. Seriously, as the title suggests this volume presents the most comprehensive study on the severity and cost of nonfatal injury in the United States. The team of authors is headed by Ted Miller, who has written extensively on the societal costs of injury and disease. The study was undertaken in response to a 1986 report of the National Research Council and Institute of Medicine entitled Injury in America. The report identified the need for a nationwide data base which could be used by policy makers and others to help direct resource allocation for injury prevention programs and establish norms or standards for injury costs. While the study should be of some interest to all economists, it is the latter goal which most directly relates to forensic economists.

Prior to the publication of this volume, the state of the art in injury cost assessment was a 1989 book which focused on injury costs of selected causes.(1) Miller et al. set out not only to comprehensively calculate injury costs by cause but also by body part, something which had not been done thus far. This latter information would be most useful for specific groups (e.g. a plaintiff's attorney desiring information on the average costs associated with knee injuries). Of particular relevance to forensic economists and attorneys is the study's findings "on the cost and length of hospital and non-hospital care, on the likelihood of partial or permanent impairment, and on the risk of temporary or permanent work loss and workers' compensation."

Chapter 1 focuses on the issues surrounding injury cost research. This study differs from the majority of traditional injury cost studies in that it measures incidence rather than prevalence costs. Incidence costs assess the lifetime costs of all injuries in a given year while prevalence costs measure total costs in a given year regardless of when the injuries occurred. The measurement of incidence costs is fraught with conceptual and data collection problems, but obviously is of far greater import to the potential user. Also, the study measures what Miller et al. term comprehensive costs rather than simply monetary costs. In addition to monetary costs, comprehensive costs include willingness-to-pay costs which allow for hedonic estimates of the value of life. This is an area in which Miller himself is particularly well versed, having written extensively on the subject.

Chapters 2 and 3 discuss the problems encountered and the solutions devised for combining data bases with different coding protocols. Chapter 3 contains discussion of the methodology for calculating the disability probabilities and impairment fractions presented in later chapters. While the concept of disability, as defined in the study, is well understood by the forensic economist, the concept of impairment may not be as familiar. An impairment fraction measures "the fraction of functional capacity typically lost to an injury." In a relatively complex process Miller et al. constructed a functional loss scale based on published physician estimates in order to compute the impairment fractions. The impairment fractions were then used in conjunction with the value-of-life estimates to compute comprehensive costs. The disability probabilities and the impairment fractions appear to have some promise for offering forensic economists tools which could be used in individual cases. I would not be so presumptuous to suggest precisely what those uses might be. Chapter 3 also contains a brief discussion of the methodology followed in calculating comprehensive costs.

Chapter 4 begins the presentation of the main findings of the study with extensive charts detailing incidence and severity of hospitalized and non-hospitalized injury. Average length of hospital stay by body part as well as disability probabilities and impairment fractions are presented here.

Chapter 5 presents the findings on injury cost. Again, the presentation of data is extensive. Forensic economists will want to read the brief discussion of the appropriate inflation rate for medical costs. The authors assert, not entirely convincingly, that use of the medical care component of the Consumer Price Index understates the true rate of medical care inflation. This reviewer would have appreciated greater elaboration in this section.

The next six chapters focus on specific injury areas: limb, back, motor vehicle, workplace, consumer product and injuries due to crime. The study concludes with a summary and recommendations for further research which focus on expanding the study's files and improving injury costing methods. Here the authors share their skepticism regarding the use of Peskin's 1984 household work study as part of the basis for their comprehensive cost estimates.

The Databook on Nonfatal Injury will stand as a seminal work in the area of injury cost measurement. Besides being enormously useful to policy makers, it could also serve as a resource for a creative forensic economist for application in a specific case. However, it is not recommended reading for that vacation next August on Martha's Vineyard.

(1) Dorothy P. Rice, Ellen J. MacKenzie, and Associates, Cost of Injury in the United States: A Report to Congress, San Francisco: Institute for Health and Aging, University of California, and Injury Prevention Center, Johns Hopkins University, 1989.

Michael J. Vernarelli(*)

(*) Chair, Department of Economics, Rochester Institute of Technology
COPYRIGHT 1997 National Association of Forensic Economists
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Author:Vernarelli, Michael J.
Publication:Journal of Forensic Economics
Article Type:Book Review
Date:Sep 22, 1997
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