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Huge costs linked to hospitalisations for firearm-related injury in the US

Just the initial hospitalisations for firearm-related injuries in the US cost an average $735m per year, with the government picking up a large portion of the tab, reports Reuters Health. According to a Stanford study, Medicaid and Medicare pay 41% of the total, and private insurers another 20%.

“Firearm-related injuries are at the heart of one of the most heated political discussions in the US, yet there is surprisingly little scientific research available on the subject,” said lead study author Sarabeth Spitzer of the Stanford University School of Medicine in California.

“It is important for all parties involved in these discussions to have a clear understanding of the monetary cost of these injuries and where the financial burden falls,” she is quoted in the report as saying.

In 2014, firearms caused about 33,700 deaths and 81,000 nonfatal injuries in the US, according to the Centres for Disease Control and Prevention. The US homicide rate is seven times higher than that of other developed countries, and the gun homicide rate is 25 times higher, Spitzer and her co-authors note.

To get a conservative estimate of the costs of firearm injuries, the researchers analysed data from the largest US database of inpatient hospital care. They focused on emergency treatment of firearm injuries that led to hospital admission, excluding re-admissions for an older injury or patients who were treated but not admitted.

Between 2006 and 2014, about 267,000 patients were admitted for firearm-related injuries, and inflation-adjusted costs totalled $6.61bn. Average costs per admission ranged from $19,600 for self-pay patients to $30,900 for Medicaid patients.

“This study underestimates the true cost of firearm-related injuries as it includes only the first inpatient admission cost,” Spitzer said. “It excludes many other important and costly steps in patient treatment such as emergency department care, readmission, rehabilitation, long-term health care and disability.”

The injury patients were overwhelmingly male across all payer groups. Patients insured by Medicaid, the federal-state insurance program for the poor, stayed in the hospital for an average three days longer than others and had injuries that were more likely to have been caused by assault.

Patients covered by Medicare, the federal health insurance programme for people over age 65, were more likely to have self-inflicted injuries and privately-insured patients had more unintentional injuries.

About 43% of all hospital admissions were in the South, which also had the highest proportion of self-pay patients. The Northeast had the lowest proportion of admissions with 16%.

Of the inflation-adjusted $6.6bn costs during the study period, Medicaid paid $2.3bn, or 34.8%; Medicare paid $0.4bn, or 6%; private insurers paid $1.32bn, or 34.8%; and self-pay individuals paid $1.56bn or 23.6%.

“We’re an outlier nation in terms of gun problems, and this only looks at a small part of the expense,” said David Hemenway of Harvard University in Boston who wasn’t involved with the study.

The study doesn’t include costs related to long-term issues such as spinal cord injuries and traumatic brain injury, as well as social or job-related costs, such as unemployment, sick leave and psychological impact on loved ones, noted Hemenway, who directs the Harvard Injury Control Research Centre.

“It doesn’t even begin to account for the real costs of losing a relative, spouse or community member,” he added. “Gun violence makes it impossible to live a good life in some of these places, especially when industry doesn’t want to move in and people are afraid to go out.”

As the first study to quantify firearm-related costs in about a decade, the data could have major implications for public policy changes and healthcare funding, said Konstantinos Economopoulos of Massachusetts General Hospital in Boston, who was not involved in the research.

In the past 30 years of funding from the National Institutes of Health, for example, six awards have supported firearm-injury studies, he said.

“The financial burden . . . falls mainly on the shoulders of the government (through Medicaid) and the uninsured,” he is quoted in the report as saying. “There is an ethical – but also financial – imperative need for an increase in funding for future research to tackle the ongoing epidemic of firearm-related injuries.”

Abstract
Objectives: To quantify the inflation-adjusted costs associated with initial hospitalizations for firearm-related injuries in the United States.
Methods: We used the Healthcare Cost and Utilization Project Nationwide Inpatient Sample to identify patients admitted for firearm-related injuries from 2006 to 2014. We converted charges from hospitalization to costs, which we inflation-adjusted to 2014 dollars. We used survey weights to create national estimates.
Results: Costs for the initial inpatient hospitalization totaled $6.61 billion. The largest proportion was for patients with governmental insurance coverage, totaling $2.70 billion (40.8%) and was divided between Medicaid ($2.30 billion) and Medicare ($0.40 billion). Self-pay individuals accounted for $1.56 billion (23.6%) in costs.
Conclusions: From 2006 to 2014, the cost of initial hospitalizations for firearm-related injuries averaged $734.6 million per year. Medicaid paid one third and self-pay patients one quarter of the financial burden. These figures substantially underestimate true health care costs.
Public health implications: Firearm-related injuries are costly to the US health care system and are particularly burdensome to government insurance and the self-paying poor.

Authors
Sarabeth A Spitzer, Kristan L Staudenmayer, Lakshika Tennakoon, David A Spain, Thomas G Weiser

[link url="http://www.reuters.com/article/us-health-firearms-us-costs-idUSKBN17128C"]Reuters Health report[/link]
[link url="http://ajph.aphapublications.org/doi/10.2105/AJPH.2017.303684"]American Journal of Public Health abstract[/link]

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