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Hospitalization Charges, Costs, and Income for Firearm-Related Injuries at a University Trauma Center
Kenneth W. Kizer, MD, MPH;
Mary J. Vassar, RN, MS;
Randi L. Harry, MBA;
Kathleen D. Layton
JAMA. 1995;273(22):1768-1773.
Abstract
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Objective.
—To quantify the actual cost of inpatient medical care for firearm-related injuries at a university trauma center.
Design.
—Retrospective case series of all hospital admissions for firearm-related injuries for the 3 years 1990 through 1992. Total inpatient financial data were examined by means of a recently instituted cost-accounting methodology.
Setting.
—Level I trauma center at a university hospital that provides trauma care and tertiary care to 3.7 million residents of 23 counties.
Patients.
—A total of 787 consecutive patients were admitted to the hospital with firearm-related injuries. Information from the trauma registry and hospital finance records were linked for 750 (95%) of these patients.
Main Outcome Measures.
—Total inpatient hospital charges, costs, revenues, and net income according to payer source.
Results.
—Men aged 15 to 44 years accounted for 77% of patients with firearm-related injuries. The overall mean and median hospital charges per admission were $52 271 and $28 033, respectively, whereas the overall mean and median hospital costs per admission were $13 794 and $7964, respectively. The net income per patient ranged from an average loss of $6980 for eacn patient having no insurance to an average profit of $28 557 for each patient with a health maintenance organization contract. The losses sustained on nonsponsored and Medicaid patients were more than offset by net income from patients having private health insurance, Medicare, or other insurance coverage such that there was an average profit of $5809 per admission for a firearm-related injury.
Conclusions.
—Treatment of firearm-related injuries produces net income for this university trauma center by virtue of the cost shifting built into its pricing structure. If data from this institution are extrapolated to the nation, then the actual cost of providing medical care for firearm-related injuries in the United States in 1995 is projected to be $4.0 billion. The majority of this cost will be paid indirectly by private health insurance.
(JAMA. 1995;273:1768-1773)
Author Affiliations
From the Department of Community and International Health (Dr Kizer and Ms Vassar) and the Division of Emergency Medicine and Clinical Toxicology, Department of Internal Medicine (Dr Kizer), University of California, Davis, School of Medicine, and the Financial Services Administration (Ms Harry) and the Trauma Program (Ms Layton), University of California, Davis, Medical Center, Sacramento. Dr Kizer is now with the Department of Veterans Affairs, Washington, DC.
Footnotes
Correspondence to: Kenneth W. Kizer, MD, MPH, Department of Veterans Affairs, 810 Vermont Ave NW, Room 800, Washington, DC 20420.
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