PROVIDENCE -- In the emergency room at Rhode Island Hospital and as a board member at the Nonviolence Institute, Dr. Megan Ranney has a view of the toll that shootings take, on the victims and their families, and the ripple effects in their communities.
Now she also has an idea of the measurable health care costs of those shootings as well -- and those costs far outweigh the cost of prevention.
In research published online in the Annals of Internal Medicine last week, Ranney and her colleagues studied the short-term health care costs of shooting survivors, those who were discharged from the emergency room, and those who were hospitalized.
They found that health care costs increase up to 20-fold in the first six months after a gunshot injury versus the six months before.
“To me, this is another piece of the puzzle on what gun violence inflicts on our society,” said Ranney, a physician researcher in injury prevention at Rhode Island Hospital and an associate professor in emergency medicine at the Alpert Medical School of Brown University.
Ranney is also the chief research officer for the American Foundation for Firearm Injury Reduction in Medicine, a nonprofit organization to fund research for preventing and treating injuries caused by guns.
“We’ve been discussing that we don’t know actual cost of gun injuries,” Ranney said. “We looked at actual costs and how much do they go up and stay up. What I thought was interesting was that costs increased dramatically six months and a year after [an injury]."
The study analyzed Blue Cross Blue Shield members in Illinois, Texas, Oklahoma, New Mexico, and Montana who were continuously enrolled for at least 12 months before and after a firearm injury from 2015 to 2017.
Ranney and her fellow researchers compared actual health care costs and utilizations within the six months before and after a shooting, regardless of how the injury occurred -- self-inflicted, accidental, criminal.
They found the total initial health care costs for shooting victims discharged from the emergency department was $8.16 million, or $5,686 per victim. The total costs for those who were hospitalized was $41.25 million, or $70,644 per victim.
Six months after the shooting, the costs for people discharged directly from the emergency room increased 347 percent, versus six months before the injury, from $3,984 to $17,806 per victim. For those who had to be hospitalized, the costs rose 2,138 percent six months later, or from $4,118 to $92,151 per victim.
The number of claims for people discharged from the emergency department increased by 187 percent, and rose 608 percent for those who were hospitalized. Claims for mental health increased by 100 to 300 percent after a shooting, which Ranney said surprised her.
“When someone gets shot, it’s life-altering in so many ways,” she said. “We know the rates of PTSD and anxiety and depression go up, so I was shocked at how low the claims of mental health were.”
Beyond the costs to the insurers, the out-of-pocket costs for the victims and their families were substantial, the researchers found.
“It can financially devastate patients and their families with enormous medical bills and lost wages,” they wrote. “At a broader level, firearm injury and violence can be detrimental to neighborhood economic health. It has been suggested that in neighborhoods with surges in firearm injury and violence, the growth of new retail and service businesses is notably diminished, leading to fewer local jobs and establishments available for residents.”
There is more work needed to determine the financial ripple effect of gun violence, Ranney said, but this is an important step to help measure how shootings have an impact on society -- especially during this unusual year that’s seen a rise in violence. Ranney said this is another cost of the pandemic.
“This spring, we’ve seen increase in violence in Rhode Island and nationally, and so it’s important for us to think about preventing it from the emotional perspective and the financial perspective,” Ranney said. “There are strategies at work -- the city has done tremendous work in reducing shootings over last decade. And it takes investment. I hope the study shows the investment is cheaper than the cost of treatment.”