Initial hospital visits for gunshot wounds cost the US $6.6 billion in nine years

And that’s just the tip of the iceberg.

Gunshot wounds are not only traumatic for the victim, they can also be financially devastating for individuals and families. Firearms injuries often involve not only hospitalizations and follow-up visits, but also long-term rehabilitation and future complications, not to mention indirect costs like lost income. With so many factors, estimating the overall economic impact of gunshot wounds across the United States isn’t easy. That’s why researchers at the Stanford School of Medicine decided to take a more targeted approach and look at costs they can be sure of. Examining data from hospitals around the country for a study published in the American Journal of Public Health, they calculated overall costs of first hospitalizations after gunshot wounds. We spoke with Stanford trauma surgeon Thomas Weiser to learn more.

ResearchGate: What are initial hospitalization costs, and what costs aren’t included in this category?

Thomas Weiser: We were interested in the medical costs of caring for patients injured by firearms. Because of how the database we used is organized, we could only look at costs during the first hospitalization following a firearm injury. We did not look at readmissions, rehabilitation, loss of income, costs of medications at home, or other potential medical costs associated with treating these patients.

RG: What inspired this study?

Weiser: No one had performed any recent analysis on the costs of hospitalizations for firearm-related injuries. Stanford is a Level I trauma center, and we care for patients injured by firearms. We wanted to know how much it costs the health system to treat these patients. There have been other studies that look at other costs, including estimating societal costs, but these are notoriously difficult to reproduce, and include a variety of potentially arbitrary factors. We wanted to look strictly at concrete costs for medical care during hospitalization.

RG: What did you find?

Weiser: We found that initial hospitalization costs totaled $6.61 billion dollars from 2006 and 2014, with annual costs of roughly $730 million. These costs underestimate the true financial impact of firearm injuries, as they do not include the costs of patients who were not admitted to the hospital as well as follow-up costs associated with these injuries such as readmission, rehabilitation, long-term healthcare or disability.

RG: How did you determine this?

Weiser: We use the National Inpatient Sample, a large database run by the Agency for Healthcare Research and Quality that includes a sampling of all patients admitted to hospitals around the country. From this database, we selected patients admitted for treatment of firearm injuries. This is fairly easy to capture using diagnostic and emergency codes. The database also allowed us to estimate costs using a formula that converts hospital charges to costs.

RG: Why is the cost so high? How does it compare to other hospital costs in the US?

Weiser: Overall, the costs are a very small fraction of our health care budget, but for individual injuries they are quite high. We noted that Medicaid patients, for example, averaged almost $31,000 per hospitalization. This is due to the intensity of care they receive: things like emergency surgery, ICU care, and hospital-based rehabilitation.

RG: Who pays for this?

Weiser: Medicare and Medicaid covers a little over 40 percent of total costs, with Medicaid paying the larger proportion. Private insurers cover about 20 percent of the costs, and individual patients are on the hook for almost 24 percent. This last group is typically uninsured or underinsured patients, and it is a huge financial burden.

RG: Can you estimate a total national cost for gunshot wounds from these results?

Weiser: We can’t, as these results only include hospital costs. I suspect the costs of lost work, disability, family leave, and the like outstrips these costs, but we did not study this. Furthermore, these costs are just for patients who are hospitalized, there are lots of people who die before reaching a hospital, and there are also those with minor injuries who are treated and released from the emergency room. These costs are not captured in our study.

RG: Why isn’t more already known about the cost of gunshot wounds in the US?

Weiser: In general, we do not know as much as we should about firearm injuries because it is seen as a sensitive "political" topic, and there are congressional limits on funding for this kind of work. In fact, it is a huge public health issue regardless of one's personal perspective on gun rights. As a practicing trauma surgeon who takes care of these patients, I would love to see these injuries reduced and even eliminated.

RG: Are there any policies or practices that could help?

Weiser: Obviously, policy changes could have a big effect. There are absolutely ways that guns can be made safer and smarter. After all, prevention is the best answer of all. We hope the high cost burden of these injuries will stimulate additional research surrounding firearm injuries in the US, particularly aimed at public policy actions that might be able to reduce the number of injuries we see.

Featured image courtesy of Phalinn Ooi.