Gunshot toll: Public foots bills, uninsured die more

Gunshot toll: Public foots bills, uninsured die more

By Dan Mangan

The public is paying hundreds of millions of dollars in hospital costs for gunshot victims who lack private insurance, according to a new study issued Tuesday.

The study, which focused on six states, also found that uninsured gunshot victims are more likely to die from their wounds at the hospital than victims with insurance.

According to the Urban Institute study, in 2010 the public footed at least 64.8 percent—and as much as 85 percent—of the hospital costs for treating firearms assault injuries in Arizona, California, Maryland, New Jersey, North Carolina and Wisconsin.

In California, for example, the public picked up the tab for $56.6 million of the total hospital costs. Nationally, $487.8 mill-ion, or almost 73 percent of the total hospital costs, were paid for by the public, the study said.

The public’s share of those costs comes from government-run insurance programs, such as Medicaid, or the patient being unable to pay, causing their costs to either be passed along to the government for reimbursement or to consumers in the form of higher prices.

“In a time of restricted public resources, these findings suggest that significant public resources could be saved or redirected if effective gun-violence prevention strategies could be identified,” the authors wrote.

An Urban Institute study last year found that gunshot victims who lack any kind of insurance are significantly more likely to be treated in the emergency room and then discharged, as opposed to victims with insurance, who are more likely to be admitted for inpatient treatment.

This led the organization to examine whether uninsured gunshot victims were more likely to die from their wounds at the hospital.

The new report found that in Maryland, for example, 21.1 percent of the victims of gun-shots who were uninsured died at the hospital, compared with 12.2 percent of the victims who were on government-run insurance such as Medicaid. In California, uninsured gunshot victims had an 11.9 percent mortality rate at the hospital, compared with 7.6 percent for those on public health insurance. New Jersey and Arizona also saw similar disparities.

Even in North Carolina, where the overall gunshot mortality rate among victims brought to a hospital was quite low, 6 percent of the uninsured victims died, compared with 3.5 percent of those on government health insurance plans. Only in Wisconsin was the mortality rate for uninsured gunshot victims in line with that of those patients with insurance.

“We’re raising this issue because there could be a quality difference” in the care given the uninsured gunshot victims, said Embry Howell, a senior fellow at the Urban Institute and a co-author of the report. “It’s something that should be investigated further.”

Howell also said that broadly speaking the study underscores the fact that “some populations are very disproportionately affected” by assaults related to firearms.

In all the states studied, males ages 15 to 24 made up at least 38 percent of all gunshot victims admitted to a hospital. Men 25 to 34 years old made up at least 23.9 percent.

African-Americans were, by far, much more likely to go to the hospital with a gunshot wound. The disparity between the races also held up among women, the institute found.

In every state but Arizona, African American women in the 15-to-34 age group went to the hospital with gunshot injuries at a higher rate than white males in the same age range.

     Dan Mangan is a reporter covering health care for CNBC.com.