HOSPITAL COSTS OF FIREARM INJURIES

The purpose of this study was to provide economic, epidemiologic, and clinical data on initial hospitalizations of patients with firearm inj uries. Design: Concurrent prospective study; data obtained by medical records review.Setting: A county university teaching hospital designat ed a level I trauma center. Subjects: 34,893 persons first hospitalize d for firearm injuries at the King/Drew Medical Center in Los Angeles from January 1978 through December 1992. Results: The aggregate hospit al cost for 34,893 firearm injuries, exclusive of professional fees, w as $264,506,455.00, of which 96% was borne directly or indirectly by p ublic funds. The charge for initial hospitalizations was $240,700,855. 00. Mean and median initial charges per case were $6898.00 and $1,022. 00, respectively (range, $944.00 to $296,232.00). The 5% of patients w ith charges greater than $100,000 accounted for 42% of all charges; 45 % of all patient days were attributable to the 4% patients, with hospi talizations lasting more than 30 days. Three thousand thirty-one patie nts were rehospitalized a total of 4,578 times; charges for rehospital ization totaled $23,805,600.00. At least 55% (75% of identifiable weap on and missile injuries) of all charges resulted from handgun injuries . Treating the majority of patients on an outpatient basis and by usin g selective angiography for extremity wounds, a savings of more than $ 775,000,000.00 resulted. The potential cost of treating gunshot wounds at a single county hospital was more than $1 billion, or more than $1 00 million per year. Conclusions: The costs for hospital treatment of firearm injuries are substantial. A lack of rehabilitation facilities forces prolonged acute hospital admissions in many cases. Avoiding pro longed hospitalization may be helpful in controlling these costs, but will be difficult to achieve. Ninety-six percent of the patients in th is report had their costs of care covered by the government, because t hey had no primary insurance coverage. Primary prevention of firearm i njuries, especially those caused by handguns, may be the most effectiv e cost-control measure.