This post is another part of a mini-series I am doing on healthcare and shootings.
First, why the designation of bullet – spewing – weapons in this post? It eliminates the discussion of whether we are talking about a pistol, a bolt action Springfield, a semi-automatic Garand, a M14 with a twenty-round clip, a M60. or a Thompson Sub.
There is a cost to owning a bullet – spewing – weapon. A cost which many people refuse to understand. There is also a responsibility in owning a weapon. It is all forgotten when it comes to rights.
The victim of the shooting pays. Thirteen year old year old DeAndre Knox pays with a lifetime of being crippled for life from a stray bullet. Society pays for an abused and deliberately misunderstood freedom. Hell, they do not even want to follow Scalia’s interpretation.
Lots of opinions and no solutions to the costs of abusive ownership.
The cost of surviving gun violence: Who pays? AAMC, Patrick Boyle
Shooting victims can survive. Survivors face ordeals of pain, medical, and mental care. The resulting collective costs to patients, hospitals, and governments are billions of dollars each year. Can the total costs result in a financial impact affecting firearm policies, laws, and medical practices?
So far the harm and pain of the injured from gun-shot wounds and the resulting collective costs to the injured and society have little or no bearing on government policy. It is the price paid for a misinterpretation of the 2nd Amendment.
Obtaining the detailed data and then analyzing the gun injuries in the United States is difficult. There is no government database of firearm incidents nationwide. There exist databases providing details about plane accidents and fatal motor vehicle accident. For nearly 25 years, Congressional spending bills did not provide dedicated federal funds to study gun injuries. In 2019 Congress funded several new projects which are limited in scope.
Congress reached a deal to fund research on gun violence for the first time in over two decades. Lawmakers allocated $25 million evenly between the Centers for Disease Control and Prevention and the National Institutes of Health for each year.
Expenses for any individual patient are difficult to track, whether it is a hospital system or providers outside of hospitals. Data points which include primary care doctors, specialists, home health aides, and therapists. It is what one trauma surgeon called a data-limited zone.
The existing data shows self-harm as the leading cause of firearm deaths in the United States. Most gun injuries (fatal and nonfatal combined) are caused by assaults and accidents. Researchers are using the databases of insurance payments and ED visits, to dig deeper for detail into the financial impact of those injuries. Among their findings:
Initial costs are high.
After shootings, most of the victims are treated only in the ED. About 50,000 a year, are treated there according to the U.S. General Accountability Office (GAO). Another 30,000 are admitted to hospitals for inpatient treatment.
In a recent Angry Bear post, we cited Emergency Room care for firearm-related injuries averaging $1,500 per patient. Also reported, the initial care for those admitted as inpatients averages $31,000. Together injuries produce an annual cost total of $1 billion in medical costs. This was taken from a 2021 GAO report. The GAO report states the total is likely underestimated. Calculations did not include some expenses not tracked in patient discharge data.
A John Hopkins study looked specifically at more than 704,000 people who arrived at EDs with firearm-related injuries found much higher costs. Covering a time period between 2006 through 2014, the study found an average per-patient ED charges of $5,254 a year. Inpatient charges were $95,887. The total costs annually were $2.8 billion.
Costs can mount after initial care.
Another study which Angry Bear briefly (we did not have access to the Harvard paper) touched upon was done by Dr. Zirui Song and associates at the Harvard Medical School and Massachusetts General Hospital. The link will take you to an open to public version. The study of survivor care published in June (Song and fellow researchers at Harvard Medical School and Massachusetts General Hospital) found medical spending for gunshot victims increased by an average of $30,000 during the first year after the injury. This is four times higher than concurrent medical spending in a control group of patients without firearm injuries. With about 85,000 firearm injury survivors each year, the study found $2.5 billion in extra spending for survivors in the first year.
Dealing with ongoing physical and psychological pain also creates ongoing expenses. During the first year after a shooting injury, survivors (compared with the control group) “had a 40% increase in pain diagnoses, a 51% increase in psychiatric disorders, and an 85% increase in substance use disorders. Also accompanied with increased pain and psychiatric medications.”
The shooting, injuries, and later trauma also impacts family and friends. There is always hope until conditions worsen. Stating such there are also the possibility of readmission which are costly. The GAO found the costs for 6% of survivors having an initial inpatient stay and were readmission at least once because of the injury, sustained an average costs of $8,000 to $11,000.
Firearm type and shooter intent affect the severity of injuries.
A College of Public Health at the University of Iowa study determined the most expensive average admission costs were for “legal interventions,” mainly as shootings by police ($33,462 per admission) and shootings with assault weapons ($32,237). The lowest cost was for unintentional injuries ($16,975).
Injuries from mass shootings can be more severe and costly.
Mass shootings account for a minority of gun-related injuries. The medical costs for those injuries average $64,976 per person, according to Chadd K. Kraus (JAMA Network Open) and other researchers from EDs and trauma services across the country. The study reviewed 403 patients from 13 incidents occurring over seven years. It incorporated all injuries, such those sustained by falling while fleeing the gunshots, as well as health care use after initial treatments.
Costs go beyond medical care.
Medical expense estimates do not reveal the full costs of firearm injuries. Expenses are also borne by other institutions handling these cases, such as police departments, justice systems, social services, and employers. Corinne Peek-Asa, MPH, PhD;
“Firearm injuries cause ripples of costs way outside the health system”
Dr. Peek was the lead author of the Iowa study on firearm types and shooter intent. alifornia San Diego (UCSD).
Another study released in July by Everytown for Gun Safety estimated that gun violence produces “an economic consequence” of $557 billion a year, including long-term medical care, criminal justice system resources, lost wages, lower worker productivity, and diminished quality of life for victims and their families.
Some More Data
A study published in 2019 by researchers at Stanford Health (including Weiser), looking at six years of patient data. It found the government takes on almost half of all hospital expenses. Out of $5.47 billion in costs during the study period;
Medicaid and Medicare paid $2.5 billion,
- private insurance accounted for $1.1 billion. and
- self-paying patients each accounted for $1.1 billion.
One expense for one person came on an insurance company statement showing charges by a company airlifting a patient from a rehabilitation center to a hospital to treat a medical emergency.
- Cost was $75,000.
And patients without insurance?
More than half of the 704,000 patients studied were uninsured or self-paying. Circumstance leaves hospitals to absorb the expenses as uncompensated care. Author Thomas Weiser:
“Your taxes, my taxes, are used to pay for the injuries to these patients. Noting most of the costs are borne by the federal and state governments, which jointly fund Medicaid. The state has a vested interest in understanding the financial implications of policies around firearms.”
Researchers stress their call to reduce gun injuries is not a call to ban guns. In fact, Peek-Asa and Kraus are gun owners. Kraus:
“I live in rural Pennsylvania, where gun ownership is common, including among physicians. I think of the implications of this research in terms of harm and risk reduction.”
Reducing the risk of firearm injuries could include policies involving manufacturing, marketing, storing weapons, training gun owners, and defining who has access to the weapons causing the most severe and expensive injuries.
The author’s points out.
“Injured lives matter. Don’t forget about them just because they lived.”
I did not include the beginning portion of this article. It is a story of a 13-year-old boy who was attending a birthday party at a friend’s home in Indianapolis when a stray bullet ripped through a window striking him in the head. Read it if you wish to read a real story. He is twenty-one now and still can not walk or talk. His ongoing struggles have included multiple hospitalizations and surgeries, physical and mental therapy, and bouts of pneumonia stemming from the progression of lung injuries. His healthcare bills are in the $millions.
We have a freedom to own bullet-spewing-weapons. We have a responsibility for the misuse of them.
Data Detailing Types of Guns and Deaths in the U.S., Angry Bear
Gun Shot Injury Costs are Twice Other Hospital Costs, Angry Bear