S. A. Spitzer1, K. L. Staudenmayer1, L. Tennakoon1, D. A. Spain1, T. G. Weiser1 1Stanford University,Palo Alto, CA, USA
Introduction:
The United States has the highest rate of firearm homicide of any developed country. In 2013 alone, firearms caused an estimated 33,000 deaths and 84,000 injuries. The frequency of these events likely generates a substantial financial burden to the healthcare system and patients. We sought to determine the costs associated with the initial hospitalization of firearm-related injuries.
Methods:
We used the Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS), the largest inpatient care database in the United States, to identify patients hospitalized for firearm-related injuries between 2006 and 2013 using ICD-9 codes. We used survey weights to generate national estimates. Charges were converted to costs using the HCUP-NIS cost-to-charge ratio files, and costs were inflation-adjusted to 2013 dollars. To determine where the burden of payment fell, we further investigated the distribution of costs across payer groups. Unadjusted and adjusted analyses were performed.
Results:
A total of 184,985 patients were admitted for firearm-related injures between 2006 and 2013. The cost of the initial inpatient hospitalization totaled $5.78 billion dollars. The largest proportion of costs was for patients with governmental insurance coverage, totaling $2.28 billion (39.4%) divided between Medicare ($0.34 billion) and Medicaid ($1.94 billion). Self-pay patients, in aggregate, were responsible for $1.41 billion (24.4%) in costs; of this group, 80.2% lived below the 50th income percentile. Privately insured patients were responsible for $1.15 billion (19.8%) in costs. While the total charges per year for all patients increased slightly over the study period ($1.98 billion to 2.83 billion, p=0.0013), total yearly costs remained the same ($671 million to $738 million, p=0.2683).
Conclusion:
Between 2006 and 2013, the costs of hospitalizations for firearm-related injuries averaged $700 million dollars per year. One third of the financial burden was placed on Medicaid, and another quarter of the cost was generated by patients with no form of insurance, indicating that firearm-related injuries place a particular burden on governmental insurance and the poor. These figures underestimate true healthcare costs, since they do not include costs of readmissions, rehabilitation, long-term care, or disability. They also exclude the costs of those who were treated and released or died prior to admission.
