Accurately determining the costs of treating firearm injuries and who pays them has proved elusive, but a recently published study sheds some light on the issue.
Stanford University School of Medicine researchers examined initial hospitalization charges for firearm injuries between 2006 and 2014 and reported that more than $734 million was spent annually, or more than $6.6 billion over the nine-year period. The researchers adjusted costs to 2014 dollars using Consumer Price Index rates.
The researchers say those figures are a small fraction of the total costs of treating gunshot wound victims and don’t include emergency department visits, such as the medical costs for patients who are treated and released without being admitted or those who are treated in the ED but die before admission. Likewise, the figures don’t include the cost of follow-up care, rehabilitation, readmission, disability, home medication or loss of work.
Thomas Weiser, M.D., associate professor of surgery at Stanford Medicine and the study’s senior author, says a number of follow-up studies are being planned to help understand the costs of readmission following discharge.
“We would like to know more about the long-term effects of such injuries on both patients and their families,” Weiser says.
The study culled information from the Healthcare Cost and Utilization Project, the nation’s most comprehensive source of health care data, and found that more than 267,000 U.S. patients were admitted for firearm-related injuries between 2006 and 2014. The study included hospitalization costs of shooting injuries that were self-inflicted, unintentional or due to assault.
Sarabeth Spitzer, the study’s lead author and a medical student at Stanford Medicine, explains in a story on the school’s website that surprisingly little research exists on gun violence from a public health perspective.
“We definitely would like to see additional research surrounding firearm injuries in the U.S., particularly aimed at public policy actions that might be able to reduce the number of injuries that occur,” Weiser says.
One key point this study illustrates is the significant financial burden that government insurance programs and the self-paying poor incur because of firearm injuries. The study found that the largest proportion of costs — nearly 41 percent — for initial hospitalization of patients was borne by patients with government insurance.
Patient demographics broken down by primary payer status were as follows:
• Medicaid: 29.1 percent
• Medicare: 6.0 percent
• Private insurance: 21.4 percent
• Self-pay: 29.4 percent
• Other payment methods: 14.1 percent
“Across all payer groups, patients were overwhelmingly male. Medicaid patients were younger, more likely to be nonwhite, and more likely to fall into a lower-income quartile than were privately insured patients,” the study reported. “Medicaid-insured individuals stayed in the hospital for an average of three days longer and their injuries were more likely to be from assault. Self-pay and privately insured individuals had the shortest length of stay compared with those in other insurance groups.”
Medicaid patients also had the highest per-incident costs, averaging more than $30,000 per initial hospitalization.
Weiser says even though this study generated a lot of information about which payers are covering hospital costs, very little is known about what patients in these situations are paying out of pocket and the financial pain points they are incurring. Likewise, the financial impact on safety net hospitals that often treat these patients needs to be explored, Weiser says.
“We did not break down hospitals by their safety net status,” Weiser says. “Typically, safety net hospitals care for a larger proportion of uninsured and underinsured patients, and these centers also have a larger burden of trauma, so budgetary changes definitely affect their operating margins. If reimbursement rates fall, [these] hospitals are in financial jeopardy, and typically turn to state mechanisms to help offset these added costs.”
For more content in the American Hospital Association’s series Hospitals Against Violence, click here.