Gun Injury Hospitalizations Drop 67% in CA

Two decades of declining firearm-related injuries in California is good news for population health, but the costs of treating patients who have been shot have risen drastically.

The number of people hospitalized for firearm-related injuries—from assaults to unintentional and deliberate self-inflicted shootings—has steadily dropped by a dramatic 67% over the last 20 years, from 10,832 in 1992 to 3,575 in 2010, according to a first-of-its kind report from California [PDF].

But even though the number of gun injuries has dropped throughout the state, the total cost and the per-day cost of caring for those injuries has gone up, from $1,859 per day to $4,120 per day. And hospitals may be absorbing a good bit of that bill.

Perhaps most significant, says Mary Tran, a research scientist with the Office of Statewide Health Planning and Development, which issued the report, "about two-thirds of the medical bill is paid by the government, which is the taxpayer."

Because government payers generally pay less than the cost of medical care provided in a hospital, that likely means that hospitals bear some brunt of the cost about two-thirds of the time persons wounded by gunshots are brought in for acute care, Tran acknowledges.

"If it's true that government payers pay less per patient, then for these cases coming in that are paid under government programs, that definitely may be a reimbursement issue for hospitals," she says.

That would mean that taxpayers paid about two-thirds of $110 million total cost of firearm injuries in 1992, and about two-thirds of $112 million total cost in 2010.

The report divides injuries according to type. The lion's share in each of the 20 years listed were shootings due to an assault, followed by unintentional shootings, self-inflicted gunshots, legal interventions (in which the injury was inflicted by law enforcement or military personnel on duty in the course of arresting or attempting to arrest lawbreakers or suppressing disturbances), and lastly, those shootings whose reason is unknown.

For example, in 2010, 2,654 of the 3,575 hospitalizations and 2,665 of the 4,755 emergency room visits were due to an assault with a firearm, such as in an armed robbery in which the gun went off and caused an injury. Unintentional shootings resulted in 548 people being hospitalized and 1,323 people being seen in an emergency department in 2010.

Over the 20 years, Medi-Cal—a combination of federal and state taxpayer funds—paid most of the cost, for example 37% of firearm injuries caused by assaults and 29.3% of the unintentional injuries. Other government payers paid 27.2% and 10.6% respectively.

Tran notes that the report contains some interesting epidemiological trends. For example, she says, in the 1990s "peace broke out in California" with respect to people hurting people with guns. Tran declined to speculate why that might be.  

The number of hospital days in 1992 was 68,200. That number dropped to $43,493 in 1996 and 29,013 in 2000. It inched back up to 37,356 in 2006 but in 2010, had dropped back to 27,176.

The report also specifies the days of the week when a hospital is most likely to see a gunshot victim. For example, assaults and unintentional shootings are most likely to result in hospitalizations on Sunday, injuries due to legal interventions occur most often on a Friday or Saturday, and self-inflicted shootings result in hospitalizations most often on Friday and Sunday.

As may be presumed, the largest share of injuries occurs in teenagers and adults from 13 through age 30, especially due to assaults. Self-inflicted shootings are the most common type of injuries in people over age 66.

The state released this report on firearm-related injuries and costs as part of a HealthFacts series that in the past has focused on disease trends. It did not issue a press release or public notice on the report as it usually does.