More than 33,000 people die from gunshot wounds every year in the United States — victims of suicide, assault, accidents, and even crossfire between armed citizens.
Most of those struck by a bullet end up in the hospital (81,000 people were hospitalized with gun-related injuries in 2014).
If you're one of those people, that injury likely brings pain and a good deal of stress. There's also a risk of disability, trauma, and further treatment required down the line.
But gun-related injuries also come with significant financial costs, both for the victim and society overall. Like most other public health issues in the United States, gun violence is an insurance cost problem.
A new study, published March 21 in the American Journal of Public Health (AJPH), found that between 2006 and 2014, hospitalizations due to firearm injuries cost the US $6.61 billion — an average of $734.1 million per year.
The cost of gun violence impacts various populations differently
Private insurance paid for $21.4% of that total cost, and individual patients took care of another $29.4%.
Government insurance — Medicare and Medicaid — paid for 40.8% of it ($2.70 billion), with most of that ($2.30 billion) coming from Medicaid, which covers 74 million people with low incomes.
Just over 63% of Medicaid patients who end up in the hospital due to firearm injury are assault victims, with only 4.6% of them hospitalized for self-inflicted wounds.
Medicare patients — a wealthier group of 57 million people that includes seniors and people with disabilities — accounted for just under $400 million in gun violence expenses. And there was another notable difference between the two groups: Just 26.1% of Medicare patients that ended up in the hospital with a gunshot wound were assault victims, while 27.7% suffered self-inflicted injuries.
The researchers suggest those disparities come down to some basic differences between the two populations.
Medicaid patients are younger and poorer, and statistically more likely to become victims of gun violence committed by other people. Medicare patients are older and wealthier, and more likely to be victims of self-inflicted wounds — a form of gun violence that's actually more common than homicide.
Because you're more likely to make it to a hospital if someone else shot you than if you shot yourself, Medicaid patients make up a larger portion of the healthcare costs.
Paying for uninsured gun violence victims
There's one more important group to consider when talking about gun violence costs: People who don't have any insurance (no Medicare, Medicaid, or private insurance), and can't afford to pay for their treatment.
The Healthcare Cost and Utilization Project Nationwide Inpatient Sample, which was the source for most of the data in the AJPH paper, counts nearly $1 billion in healthcare costs as paid for by "other" sources.
That means hospitals are absorbing the costs themselves (primarily teaching hospitals in big cities, which have the most resources and see the most gun violence patients). But the authors point out that the buck doesn't really stop with Mt. Sinai, Johns Hopkins, or any other big hospital system. If those institutions had to shoulder the costs of thousands of gunshot victims, they'd likely collapse.
Instead, those unpaid treatments get written off as losses, which means federal and state governments end up funding them through block grants and backdoors in the tax code.
Uninsured gunshot victims benefit, in other words, from a very inefficient form of government-subsidized healthcare, which only kicks in after dire emergencies.
The full picture is bigger than $6.61 billion
The numbers in this study, big as they are, represent just a fraction of the total strain gun violence puts on the American healthcare system.
As the authors write, that $6.61 billion in expenses only accounts for initial admissions and treatments — the costs of patients who turn up at the hospital after getting shot.
But there's a whole set of medical expenses that go beyond that emergency, day-one treatment.
Patients might have follow-up surgeries to fix problems not addressed when they were first treated in the emergency room. They might need physical therapy to gain back a range of motion, or a home healthcare worker to help with basic tasks if they've suffered a crippling injury.
None of those costs turn up in this research. So $734.1 million per year is just the beginning.
