Healthcare expenses continue to be a major focus in planning for the needs of the population in the years to come. While many costs associated with disease processes are well known, the impact of violence upon the healthcare system remains one of the least explored. In 1979, a report entitled Healthy People stated that the consequences of violent behavior should not be ignored for improving the nation’s healthcare. Furthermore, it recommended addressing violence as a top priority for healthcare. Almost a decade later, the World Health Organization made similar recommendations regarding the importance of addressing violence in order to make the world both healthier and safer.
Incidents of violence affect both the general medical and the mental health systems, with expenditures including both direct as well as indirect costs. Direct costs are those which come from treatment and rehabilitation while indirect costs are based on definitions related to lost productivity, disability and premature death. As violence is a preventable act that greatly impacts the individual, family and society, information regarding these expenses should be utilized to support the healthcare budget and target the reduction of violence. Similarly, a unified focus on the part of healthcare professionals to educate and work to prevent violence should be part of daily practice and interactions with patients.
Medical Costs: Domestic Violence, Guns, Violent Crimes
Treatment of violence in healthcare can be seen in all settings, including emergency departments, as well as inpatient and outpatient surgical, orthopedic, primary care medicine, and mental health. Acts of violence that result in injury, up to and including loss of life, can include homicides; suicides; use of weapons like guns or knives; road rage; child abuse; physical violence; sexual violence; rape; and domestic violence. There are direct and indirect costs associated with all types of violent acts. While healthcare costs are the focus of this article, additional costs are tied to law enforcement, legal, court, public monitoring and response agencies, incarceration, special school programs, and others. It should similarly be noted that it is difficult to quantify expenses of the collateral damages associated with those who witness and are exposed to the violence. A recent study from University of New Hampshire found that one in four children witness violence between their parents.
Of the various acts of violence and associated healthcare costs, it appears that the costs associated with domestic violence are the most reported. A CDC study in 2009 reported that there are 32 million victims of domestic violence annually. In data from 2001, 700,000 known domestic violence incidents were documented. “The health-related costs of rape, physical assault, stalking, and homicide against women by their intimate partners exceeds $5.8 billion annually,” reported the CDC. Women were found to use the emergency room and inpatient treatment more than men. Similarly the direct medical costs for women were approximately three times higher than for men. Lost productivity, an indirect cost, was only slightly higher for women than for men. Given that expenditures have been reported to be growing at 7.3 percent annually, current figures for these expenditures would equal approximately $10 billion.
Additional CDC studies in 2003, based on 1995 data, reported direct health costs of domestic violence as $4.1 billion with an additional $1.8 million in lost productivity. Based on healthcare inflation and rising fees, we postulate that the costs are significantly higher at this time. Currently, a conservative estimate on these figures would yield $8.2 billion for healthcare costs associated with domestic violence as well as $3.6 million in lost productivity.
Also significant are the costs associated with gun violence. “The net costs of gun violence to the medical system are on the order of $400 million to $1.2 billion,” according to one study. Researchers report that the “review suggests that the costs of gun suicides and accidents is on the order of $10 to $20 billion per year, bringing the total costs of all gunshot injuries in the U.S. to about $100 billion. To put this number into perspective, $100 billion could be used to cover nearly two-thirds of those in America who are currently without health insurance, or to pay college tuition at a good public university for 27 million people – roughly the entire population of New York and New Jersey combined. And this reflects the costs of gun violence for just one year.”
If data is expanded to include knives and injuries stemming from rape, robbery, assault, murder and arson, the associated costs similarly increase. “In 1987 physical injury to people age twelve and older resulting from rape, robbery, assault, murder, and arson caused about $10 billion in potential health-related costs, including some unmet mental health care needs. It led to $23 billion in lost productivity and almost $145 billion in reduced quality of life (in 1989 dollars),” reports another study in Health Affairs.