Uninsured gunshot victims get different, more expensive care, Urban Institute study shows

Most of the people who come to the emergency room with gunshot wounds have no insurance, and if they're admitted as inpatients, hospitals will spend an average of $23,500 caring for them, according to a new study (PDF) of gun trauma and healthcare costs.

But the study from the Urban Institute found that gunshot victims' uninsured status may affect their care. “Uninsured victims of firearm assaults appear to have different treatment when they arrive at the ED. Their ED visits are the most expensive, they are admitted for inpatient care less often, and their treatment, once admitted, appears to be less intensive,” the study says. “The numbers indicate that some hospitals may be making treatment decisions based on the insurance status of the patient rather than the patient's condition.”

That sobering analysis comes one week after the American Hospital Association released its own report, ”Reducing Violence in Our Communities” (PDF), that described how hospitals in 11 different cities are running or participating in programs that work to prevent violence in communities.

The AHA profiled the programs with the intention that other hospitals could duplicate them elsewhere. Many involve using peer-to-peer counseling and enrollment of patients in social resources and life-skills coaching to help break “the cycle of violence.”

“Every hospital copes with the effects of violence, not only on patients and their families but on the entire community,” AHA President and CEO Rich Umbdenstock wrote in an introduction to the program. “Some hospitals have found in this sad reality some important opportunities to take innovative action.”

For hospital executives not moved to action solely by the human toll of gun violence, the Urban Institute study quantified the financial impacts in its analysis.

The study found that hospitals provided $629 million in healthcare to victims of gun violence in 2010. Most of that cost—$588 million—was for inpatient care, even though the researchers also concluded that a higher-than-expected number of gunshot victims are never admitted, but rather treated and released from the emergency department for an average cost of just $1,100.

The rate of emergency department visits for firearm injuries for people without insurance ran nearly three times the national average of gunshot hospitalizations, the study found. The group with the highest rate of hospital use for firearm assaults was men between the ages of 15 and 24, and those who present to the ED with bullet wounds disproportionately live in low-income ZIP codes.

The Urban Institute authors note that while Medicaid programs already cover a large share of the costs of healthcare related to gun violence, those costs are likely to increase in coming years with the expansion of Medicaid eligibility rules in many states stemming from the Patient Protection and Affordable Care Act.

“Many of the low-income uninsured victims of firearm assaults, especially young males, will become eligible for Medicaid and other forms of insurance,” the study says. “As the nation turns to efforts to control the cost of health care through prevention strategies, the prevention of firearm assaults should receive increased attention as a high public health priority.”

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