The Healthcare Costs of Gun Violence in Nevada

December 10, 2015

Gun violence takes a heavy toll on the health and wellbeing of Nevadans — 395 Nevadans were shot to death in 2013 alone — but treating firearm injuries also takes a significant bite out of the state’s pocketbook. To assess the healthcare costs of gun violence in Nevada, Everytown for Gun Safety analyzed state inpatient hospitalization data between 2005-2014. This analysis shows that the cost of treating victims of gun violence runs into the tens of millions of dollars each year. Effective measures to prevent gun violence and reduce hospitalizations for firearm injuries could provide significant savings to the state’s taxpayers.

Treating Firearm Injuries Costs Nevada Millions of Taxpayer Dollars: Firearm injuries cost Nevada hospitals almost $246 million over the last 10 years — over $40 million in the most recent year. And hospital costs likely represent a mere fraction of the total societal cost of gun violence to Nevadans, which also includes apprehending and incarcerating offenders, forgone wages of the victims, lost property taxes due to depreciation of real-estate, and the pain and suffering of survivors.

Hospitalizations for Gun Violence are Common: Over the last 10 years, there were at least 2,389 inpatient admissions as a result of firearm injuries in Nevada — an average of 239 a year.

The Public Pays the Bulk of the Cost: More than half of the costs of hospitalizations for firearm injuries were charged to public insurers, such as Medicare and Medicaid, or from charity, costing taxpayers more than $13.3 million in an average year.

Victims of Gun Violence Require More Hospital Care than Victims of Other Violent Injuries: Hospitalizations for firearm-related injuries result in almost twice the charges per incident as hospitalizations from stabbing injuries.

 

Background

Previous research has shown that medical care for people with firearm injuries is costly and paid for disproportionately from the public purse. In one of the first such accounts, economists Phillip J. Cook and Jens Ludwig analyzed national hospital statistics from 1994 in New York and Maryland, and determined that an average non-fatal gun injury resulted in $14,605 in acute hospitalization costs ($23,330 in inflation-adjusted 2014 dollars) — which comprised only 41 percent of the total lifetime medical costs of the injury.Cook PJ, Lawrence BA, Ludwig W, and TR Miller, “The Medical Costs of Gunshot Injuries in the United States,” JAMA Aug 4 1999, 447-54. The authors estimated that the medical costs of treating gunshot injuries nationwide summed to $2.3 billion ($3.7 billion in 2014 dollars). Using more recent data, Ted Miller of the Pacific Institute for Research and Evaluation estimated that the average hospital-admitted firearm injury resulted in $49,947 in medical care costs.Miller, Ted R. Children’s Safety Network Economics and Data Analysis Resource Center — Pacific Institute for Research and Evaluation, December 2012. http://bit.ly/1HUhW2K<

The cost of a hospitalization for a gunshot injury is just a fraction of the total social cost, which includes the wages forgone by victims, the cost of apprehending and incarcerating the perpetrators, the depreciation of real estate and resulting loss in property taxes,Center for American Progress, The Economic Benefits of Reducing Violent Crime. http://ampr.gs/1MNJEni and the pain and suffering experienced by the survivors. Economists have made an evolving series of estimates of the total social costs of gun violence nationwide, ranging from $46 billionHemenway, David (2011). Costs of Firearm Violence: How You Measure Things Matters. Social and Economic Costs of Violence: Workshop Summary — Forum on Global Violence Prevention. to $100 billionCook, P.J., and Ludwig, J. Gun violence: The real costs. New York: Oxford University Press, 2000. to $229 billion annually.Follman, M., Lurie, J., Lee, J., & West, J. (2015, April/May). Mother Jones: What Does Gun Violence Really Cost? Retrieved November 1, 2015, from http://bit.ly/1SUhyHV

This study examines the narrow but directly measurable cost of inpatient treatment of firearm injuries in hospitals in Nevada.

 

Data

Everytown obtained data on inpatient costs for all gunshot victims in hospitals and ambulatory surgical centers in Nevada between 2005-2014 from the Center for Health Information Analysis for Nevada (CHIA), a research center under contract with the Nevada Department of Health and Human Services.

CHIA provided deidentified data describing each hospitalization including year; hospital of treatment; victim gender, race, and age group; type of primary payer;As many as three payers may be represented in the actual data, but were not available for this analysis. Additionally, the data represent the charges of the treatment but do not indicate whether or not they were paid. injury code; and total charges rounded to the nearest dollar.In 2010, hospitals began submitting data to CHIA using a new form. This delayed classification of hospitalization reports beginning in 2009, and appears to have artificially reduced the number of reported firearm-related hospitalizations during that period. This analysis relies on the reported data CHIA categorizes the incidents as accidental, assaultive, or suicidal, and by firearm type used in the shooting if known. Everytown grouped payers into six groups: public insurers, private insurers, workers compensation, self-pay (in which the injured person was the primary payer or was pending Medicaid or county coverage referral), and other types.CHIA healthcare data organized payers into fifteen subgroups. See Appendix, I. for Everytown subcategorizations

Everytown supplemented this data with publicly available population data from the Nevada Department of Taxation.

 

Results

Between 2005 and 2014 there were 2,389 hospitalizations for firearm injuries in Nevada. In total, these incidents generated healthcare charges of almost $246 million, including over $40 million in the most recent year. Hospitals in Clark County accounted for 83 percent of statewide hospital charges due to gun violence.

The majority of hospitalizations were for assaultive injuries — those inflicted deliberately by one person on another. Together, they accounted for 61 percent of total hospitalizations for firearms injuries and 66 percent of total charges, $163 million. On average each incident resulted in $111,500 in charges for treatment.

Accidents accounted for the next largest share of hospitalizations, 15 percent of the total. Treatment for these incidents was less costly on average, at $72,290 per case.

Attempted suicides with firearms accounted for a smaller number of hospitalizations — 14 percent. The vast majority of suicide attempts with firearms are fatal,Miller, Matthew; Azrael, Deborah; Hemenway, David. The epidemiology of case fatality rates for suicide in the Northeast. Annals of Emergency Medicine. 2004; 723-30. but those who survive and are hospitalized appear to require high levels of care: average hospitalization charges for these injuries was $115,000.

The high overall cost of treating firearm injuries in Nevada was driven by the small share of injuries with the costliest hospitalizations. Firearm injury hospitalizations that resulted in more than $200,000 in charges accounted for just eleven percent of total hospitalizations but 45 percent of costs.

The majority of costs for healthcare treatment of firearm injuries in Nevada fell on public payers such as Medicare, Medicaid, and Indigent Referrals — $13.4 million annually, on average. Medicaid, a form of public insurance available to people with categorical disabilities or an individual income below 133 percent of the poverty line ($16,105 in Nevada in 2015Norris, L. (2015, September 26). Nevada Medicaid. Retrieved from http://bit.ly/1OeEwp3.) was the largest public contributor, accounting for over 19 percent of charges. Medicare, which is administered by the federal government and provides health insurance for Americans aged 65 and older, was charged an additional seven percent. Because a high share of suicide victims were 65 and over, Medicare covered a disproportionate share of the charges for those hospitalizations. Less than a quarter of firearms-related hospital bills in Nevada had “self-pay” as the primary payer, although an unknown share of hospitalizations in this category were pending Medicaid or county coverage referral, and some of these charges may have been assigned to different secondary or tertiary payers. Private insurers were charged for 12 percent of the total.

Firearm injuries account for a disproportionate share of costs of treating violent injuries in part because the physical damage inflicted by firearms can be so catastrophic. Prior research has shown that the cost of hospital treatment of gunshot wounds was more than twice that of treating stab wounds.Mock, Charles, Susan Pilcher, and Ronald Maier. “Comparison of the Costs of Acute Treatment for Gunshot and Stab Wounds: Further Evidence of the Need for Firearms Control.” Journal of Trauma and Acute Care Surgery. (1994). The authors found that “mean and median charges were higher for gunshot wounds ($14,541; $7,541) than for stab ($6,446; $4,249). Data from Nevada is consistent with this: an average hospitalization for an injury with a knife, sword, or dagger resulted in $53,502 in charges, whereas hospitalizations for gunshot injuries cost $104,228, almost twice as much.

 

Appendix

See below for more data used to compile this fact sheet.