The Hidden Cost of Gun Injuries Pushing Trauma Centers to the Brink

Medicaid reimbursements rarely cover full treatment costs, forcing trauma centers to bear heavy losses amid rising gun violence.

Between 2016 and 2021, the first round of hospital care for firearm-related injuries cost the U.S. health system an estimated $7.7 billion. The greatest financial burden was carried by urban trauma centers, particularly those treating large numbers of Medicaid patients, according to research from Northwestern Medicine ().

The study analyzed emergency department and inpatient visits for firearm injuries between 2016 and 2021. Annual costs held steady at about $1.2 billion through 2019, then jumped to $1.6 billion in 2021, a 33% increase that coincided with a rise in firearm injuries during the COVID-19 pandemic.

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#Gunviolence is crippling safety-net hospitals. More than half of #firearminjury costs hit Medicaid, but low #reimbursement means hospitals absorb massive losses. Looming #Medicaid cuts will only strain care for the most vulnerable. #Health_Insurance

Medicaid Shortfalls Strain Hospitals Fighting Gun Violence

More than half of all firearm injury costs were billed to Medicaid. Yet, Medicaid reimbursement often falls short of actual treatment costs, leaving safety-net hospitals, which serve vulnerable, lower-income patient populations, on the front lines of the gun violence epidemic to absorb substantial losses. The study authors warn that recent Medicaid funding cuts adopted by Congress could further strain these hospitals.

The findings were published in JAMA Health Forum.

“Gun injuries are a source of financial strain on hospitals, particularly large safety-net trauma center hospitals that often operate on thin margins,” said study corresponding author Alexander Lundberg, assistant professor of emergency medicine at Northwestern University Feinberg School of Medicine.

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“Because in many states Medicaid reimbursement is typically below the true cost of care, trauma center hospitals are already absorbing significant losses,” added study co-author Dr. Anne Stey, assistant professor of surgery at Northwestern University Feinberg School of Medicine and a Northwestern Medicine trauma surgeon.

“Medicaid funding cuts could further financially destabilize trauma centers. Some could close, or stop being trauma centers that provide the high-level and life-saving trauma care that all American families need after car accidents, falls and bike accidents.”

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Overall, the largest share of costs went toward treating patients who were Black, men and from low-income areas.

Six States Provide High-Quality Data on Firearm Injury Costs

To get a national picture of the health care costs of firearm injuries, the scientists analyzed hospital records from six states: Arkansas, Florida, Maryland, Massachusetts, New York and Wisconsin. The team chose these states because they collect high-quality data on both inpatient hospitalizations and emergency visits.

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The team analyzed every hospital visit in those states for a new firearm injury from 2016 to 2021 and then used these patterns to generate national estimates. To find out where in the health system the costs are most concentrated, the team broke down the data by patient demographics, hospital size and health insurance coverage, among other factors.

The initial treatment of firearm injuries cost U.S. hospitals $7.7 billion from 2016 to 2021
Annual costs stayed stable from 2016 to 2019 (about $1.2 billion per year) before climbing to $1.6 billion in 2021
The annual cost of treatment for pediatric patients grew 54% from 2019 to 2021
Medicaid was the primary payer for 52% of all hospital costs, followed by private insurance (20%), self-pay or uninsured patients (16%) and Medicare (6%)

The Northwestern team notes that their estimate likely understates the complete financial toll of firearm injuries.

Their analysis included only the initial hospital stay or emergency visit and did not capture other significant health care costs related to firearm injuries, such as ambulance or air transport, rehabilitation, follow-up visits and return to hospital.

The study also does not account for indirect costs to American families such as lost wages of patients and their caregivers, long-term disability or the emotional and economic burden on communities.

Lundberg and colleagues say their findings highlight the need to strengthen financial support for trauma center hospitals to sustain trauma care in their communities most affected by gun violence.

The authors also call for more investment in injury-prevention programs and safe-firearm storage education to prevent unauthorized firearm access.

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