Increases in Actual Health Care Costs and Claims After Firearm Injury

Ann Intern Med. 2020 Dec 15;173(12):949-955. doi: 10.7326/M20-0323. Epub 2020 Sep 29.


Background: The incidence of firearm injury and death in the United States is increasing. Although the health care-related effect of firearm injury is estimated to be high, existing data are largely cross-sectional, do not include data on preinjury and postinjury health care visits and related costs, and use hospital charges rather than actual monetary payments.

Objective: To compare actual health care costs (that is, actual monetary payments) and utilizations within the 6 months before and after an incident (index) firearm injury.

Design: Before-after study.

Setting: Blue Cross Blue Shield plans of Illinois, Texas, Oklahoma, New Mexico, and Montana.

Participants: Plan members continuously enrolled for at least 12 months before and after an index firearm injury sustained between 1 January 2015 and 31 December 2017.

Measurements: Eligible costs, out-of-pocket costs, and firearm injury-related International Classification of Diseases, Ninth or 10th Revision, codes.

Results: Total initial (emergency department [ED]) health care costs for persons with index firearm injuries who were discharged from the ED were $8 158 786 ($5686 per member). Total initial (hospital admission) costs for persons with index firearm injuries who required hospitalization were $41 255 916 ($70 644 per member). Compared with the 6 months before the index firearm injury, in the 6 months after, per-member costs increased by 347% (from $3984 to $17 806 per member) for those discharged from the ED and 2138% (from $4118 to $92 151 per member) for those who were hospitalized. The number of claims increased by 187% for patients discharged from the ED and 608% for those who were hospitalized.

Limitation: Firearm injury intent was not specified because of misclassification concerns.

Conclusion: In the 6 months after a firearm injury, patient-level health care visits and costs increased by 3 to 20 times compared with the 6 months prior. The burden of firearm injury on the health care system is large and quantifiable.

Primary funding source: None.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Child
  • Child, Preschool
  • Emergency Service, Hospital / economics
  • Female
  • Health Care Costs / statistics & numerical data*
  • Health Expenditures / statistics & numerical data
  • Hospitalization / economics
  • Humans
  • Infant
  • Male
  • Middle Aged
  • United States / epidemiology
  • Wounds, Gunshot / economics*
  • Wounds, Gunshot / epidemiology
  • Young Adult