Gun violence means big hospital costs

On any given night at Presley Regional Trauma Center at the Regional Medical Center in Memphis, Tenn., between two and three patients will be rushed into the emergency department with gunshot injuries – usually with multiple shot wounds from semi-automatic weapons, said Timothy Fabian, Department of Surgery chair at the University of Tennessee Health Science Center in Memphis.

This inner-city hospital sees between 700 and 1,000 patients a year in the ED from gunshot wounds – 80 percent or so of which have no means of insurance coverage when they arrive. About a quarter of all Presley’s admissions are from gunshot wounds, and a third to half of all gunshot wounds are likely related to illegal drug activity, he said.

“Semi-automatic weapons are so prevalent and easy to come by, and when someone is shot by one they aren’t just shot once, but sometimes three to six times. The wounds are much more devastating from these weapons,” said Fabian. “It costs a lot more for rehabilitation, which, because many patients don’t have insurance, they don’t end up having. Their outcomes end up being much poorer than they would have had they been able to get rehabilitation.”

A recent Urban Institute report examined the costs of emergency department visits and hospital admissions for firearm assaults in the U.S. based on 2010 data and found that the total firearm cost for U.S. hospitals that year was just under $630 million.

Embry Howell, author of the report and a senior fellow with the Urban Institute’s Health Policy Center, said in 2010, there were 36,341 emergency department visits (11.8 visits per 100,000 people) and 25,024 hospitalizations (8.1 visits per 100,000 people) due to firearm assaults. Just over half of the hospital costs incurred were for those with public insurance, mainly Medicaid, and another 28 percent of the costs were for the uninsured, according to the report.

“Inpatient costs for these incidents are very expensive and we suspect that our data is likely underreported,” said Howell. The cost of a stay for a firearm assault injury was nearly $14,000 more than the average inpatient stay in 2010, she said.

According to the report, other findings include:

• young males (ages 15 to 24) are the most common firearm victims, visiting the ED almost seven times more than the national average
• people who reside in the lowest income zip codes are about twice as likely to have an ED visit or be admitted to the hospital for firearm assault injuries
• ED usage rates for firearm assaults vary by U.S. census region, which correspond to the higher reported household gun ownership in the South (35 percent) and Midwest (38 percent), compared with the West (27 percent) and the Northeast (22 percent)
• uninsured patients are less likely to be admitted to the hospital than insured patients – a discrepancy that could be due to a hospital’s reluctance to admit a patient without insurance coverage, a higher ED mortality rate for uninsured firearm assault victims, an effort by the hospital to obtain insurance for a patient once he or she is admitted, or differences in the severity of injury between the insured and uninsured

Howell noted that with the implementation of the Affordable Care Act, many low-income uninsured victims of firearm assaults (including many young males) will become eligible for Medicaid and other forms of insurance, and as the country focuses on lowering healthcare costs through prevention methods, decreasing firearm assaults and injuries should receive attention as a public health priority.

“Bottom line is this is a prevention issue – a public health issue. It’s a potentially preventable condition,” she said.

Gunshot wounds are much more severe and complicated now than they often were two decades ago simply because the weapons used have the ability to “fire off as many rounds as your finger can pull,” said Babak Sarani, associate professor of surgery and chief of trauma and acute care surgery at the George Washington University Hospital in Washington, D.C.

“When someone is shot too many times, it usually leads to death, but if it’s twice or three times, we can save them, which is, of course, a lot of time and resources,” he said. “The injuries are often very complicated due to multiple gunshot wounds. The victim often has muscle and nerve damage and multiple surgeries and specialists are involved in the recovery,” he said.

If the country and hospitals are going to get a handle on the financial and societal costs of gun violence, Sarani said, a “reasonable approach to gun control” will need to be found – something that has been politically impossible, he noted. “There are no easy fixes.”