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Friday, September 4, 2020

Brown study puts a price on the cost of gun violence

Firearm injuries cost a per-patient average of $8.2 to $41.2 million to treat, study finds

Brown University

How much does a treating a gunshot injury cost? New research says the answer is $8.2 million for those with an emergency visit only — and a staggering $41.2 million for injuries that require hospital admission.

The incidence of firearm injury and death in the United States is increasing, and though the impact of these injuries on health care providers is estimated to be high, research to date has not investigated data on pre- and post-injury health care visits and related costs.

To close that gap, a team led by Dr. Megan Ranney — an emergency physician and associate professor of emergency medicine and health services, policy and practice at Brown University — conducted a study that found that in the six months after surviving a firearm injury, patient health care costs increased three to 20 times, depending on whether the person was hospitalized, compared to the six months prior to injury.

“When you look at the reasons to prevent firearm injury, you want to do so because it hurts people,” said Ranney, who is also chief research officer for the American Foundation for Firearm Injury Reduction in Medicine. “You want to prevent firearm injury because of the emotional aftermath. You want to prevent firearm injury because it’s wrong to let people get hurt. But for some people, they may want to prevent firearm injury because it’s expensive.”

The findings were published in the Sept. 29 issue of the journal Annals of Internal Medicine.

Using insurance claim data from the five states — Texas, Illinois, Oklahoma, New Mexico and Montana — in which Blue Cross Blue Shield (BCBS) operates under the umbrella of the Health Care Service Corporation (HCSC), the team analyzed changes in actually health care costs and utilization rates in the six months following a firearm injury, relative to the six months prior to it.

Patients must have been continuously covered by a BCBS insurance plan for at least 12 months before and after a firearm injury sustained at any time from 2015 to 2017.

“This view outside of the usual (and still very important) public health perspective allows us to see not just the uninsured and Medicaid population, but individuals who have group coverage,” said Leanne Metcalfe, affiliate faculty at the University of Texas Health Science Center and a study co-author. “This could be your co-worker, your boss, someone’s spouse or someone’s child.”

Overall, 2,019 members (representing 19,440 claims) had an index  emergency department (ED)  or hospital visit for a firearm injury during the study period. In comparing the six-month periods before and after the initial firearm injury visit, the number of insurance claims increased 187% for patients discharged from the ED and 608% for those hospitalized. Mental health claims for the same group during the same periods increased 106% and 319%, respectively.

Translated into dollars, that means that the total initial health care costs for the ED visit for a firearm injury discharged from the ED were approximately $8.2 million, or $5,686 per member on average. 

Total healthcare costs for hospital admission, inclusive of an ED visit, for a firearm injury requiring hospitalization were $41.2 million, or $70,644 per member on average.  Per member (ED) costs increased 346%, from $3,984 to $17,806. 

For those hospitalized, their costs went up a staggering 2,138%, from $4,118 to $92,151.

There’s that old metaphor about the blind man trying to feel an elephant and identify all the different parts — this is just another part of that puzzle about what the overall costs of firearm injury are for our society.

On average, out-of-pocket costs increased 133% for those discharged from the ED and 644% for those hospitalized, comparing the six months before and after the injury.

“It adds to the literature in a different way, showing that firearm injury is super expensive, not just at the time that someone’s hurt, but also going forward,” Ranney said. 

“This study shows just a snippet of the overall costs, and so therefore my call is for insurers and governments and health care systems to take this on as an imperative for prevention.”

In fact, Ranney said, the results are most likely an underestimate of the overall costs associated with firearm injury. There are costs associated with education and missed schooling, costs around anxiety, fear and emotional rehabilitation, and negative economic impacts on communities with higher instances of firearm injuries. There are the intangible, difficult-to-quantify costs associated with quality of life or emotional well-being.

“There’s that old metaphor about the blind man trying to feel an elephant and identify all the different parts — this is just another part of that puzzle about what the overall costs of firearm injury are for our society,” she said.

And the study didn’t include those on Medicaid, those who are uninsured, or those who may have experienced a gap or lapse in insurance coverage — a reality for tens of millions of Americans.

“The findings of this study powerfully demonstrate how firearm injuries could strain health care systems and devastate communities,” said study co-author Ali Rowhani-Rahbar, an associate professor of epidemiology at the University of Washington. “The profoundly negative economic, as well as physical and psychological consequences of firearm injury perpetuate the cycle of violence and deepen inequities faced by our most vulnerable communities.”

Metcalfe said one of the more surprising aspects of conducting this research was the response she and others received when reviewing the results of the study.

“It was amazing how many people... weren’t able to comprehend that higher-income individuals could also be gunshot victims, or that injuries happen outside of high-crime neighborhoods,” she said. “The reaction is further evidence the study is just so important and why the data collection and availability can lead to data-driven solutions to help us properly treat gunshot wounds and hopefully prevent future injury.”

Ranney and the other researchers agree that seeing firearm injury as something that is preventable, and not a hopeless or predetermined cost, is the single most important step in beginning to reduce the number of firearm injuries. Investing resources in practices like identifying high-risk individuals and engaging them in community programs or treatment, as well as safe firearm storage solutions, is crucial. 

 “This is absolutely a moment where we should redouble our efforts to prevent future injury, as well as, again, preventing those kinds of downstream health consequences,” Ranney said.

In addition to Ranney, Rowhani-Rahbar and Metcalfe, other authors on the study were Jeremiah Schuur, Curtis Herges and Paul Hain.