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Abstract
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In 1983, Los Angeles County designated 23 level I or II trauma centers. During the subsequent 7 years, ten centers closed because of adverse financial impact. To analyze the causes of this trend, hospital admissions for gunshot and stabbing injuries were reviewed for two separate 1-year periods at a level I urban trauma center. Of 1,160 patients arriving with injuries meeting county triage criteria from January 1, 1986 through December 31, 1986, 323 (27%) sustained penetrating assault, of which 96 were with firearms (30%). From January 1, 1988 through December 31, 1988, 1,213 met triage criteria; 301 (25%) were intentional, of which 179 (59%) were due to firearms. Epidemiologic and clinical data from the two periods is similar with 90 per cent of the patients being men ages 25 to 30 and of minority ethnic background. Seventy-five per cent of the patients required a truncal operative procedure and needed about 5.5 days of hospitalization. Overall, mortality averaged 4.7 per cent and morbidity 14.5 per cent. Complete financial data was available on 561 of the 624 intentionally injured patients for which costs totaled $2,481,346 (mean = $5,260 for gunshots; mean = $3,640 for stab wounds). The total collections were $545,896 (22% of total charges). Only 5 per cent of the charges were reimbursed from insurance; MediCal reimbursed 13 per cent and only 1 per cent was from Medicare. Eighty-one per cent of the patients had no financial resources, resulting in a hospital deficit of $1,861,009 (75% of the total charges).(ABSTRACT TRUNCATED AT 250 WORDS)
VioLit summary:
OBJECTIVE:
This research conducted by Klein et al. analyzed the medical and social impact of intentional injuries.
METHODOLOGY:
The authors used a quasi-experimental, cross-sectional research design that was retrospective in nature. Their study was comprised of a secondary analysis of data obtained from the medical registry and clinical records at a level I trauma center in Los Angeles county for two separate 1-year periods, 1986 and 1988. The sample consisted of 624 patients who were classified as having nonaccidental injury (gunshot and stabbing victims), with 323 patients falling into this category in 1986 and 301 in 1988. The variables used in the study were demographic characteristics (including sex, age, race, ethnicity, employment status, and extent of insurance coverage), mechanism of injury, frequency of operative intervention, intensive care unit requirements, and outcome of patients (whether they lived or died and how much injury they sustained). Comparison between the two time periods was made using the t test.
FINDINGS/DISCUSSION:
In 1986, 27% of patients admitted to the hospital were intentionally injured, while in 1988, 25% were. Ninety percent of the patients in the study were men aged 25 to 30 and of minority ethnic background (Black or Hispanic). Eighty percent were unemployed at the time of the assault. Fifty-one percent of the patients required immediate surgical intervention. The average hospitalization for the patients was 5.5 days, and the total costs of the patients stays at the hospital for the two years combined was $2,481,346 with a mean cost per patient of $4,423. The hospital collected only $546,896 of the total costs incurred by the patients, close to one fourth (22%) of the amount owed. Eighty-one percent of the patients had no financial resources leaving the bulk of their amount owed up to the taxpayers of Los Angeles county. The authors suggested that this financial burden placed on public hospitals forces them to compromise their other health care roles and is a major factor in their reluctance to participate in the trauma network in Los Angeles County.
AUTHORS' RECOMMENDATIONS:
The authors recommended that, although costs alone should not dictate decisions, their study certainly pointed to several problems that must be addressed. They argued that assault injuries occur in predictable and regular patterns with certain groups, such as by age, education and environment. Furthermore, these groups should be confronted directly with increased enforcement of existing prevention strategies as well as the enactment of new strategies, such as gun control laws. They proposed that effective prevention through education, legislation, enforcement, and medical leadership is the best way to reverse the financial drain imposed on hospitals through their treatment of assault injuries.
(CSPV Abstract - Copyright © 1992-2007 by the Center for the Study and Prevention of Violence, Institute of Behavioral Science, Regents of the University of Colorado)
California
1980s
Socioeconomic Factors
Physical Assault Effects
Physical Assault Victim
Victim Injury
Cost Analysis
Violence Effects
Violence Injury
Public Health Approach
Public Health Services
Hospital Visits
Urban Violence
Emergency Room Visits
Adult Injury
Adult Victim
Juvenile Injury
Juvenile Victim
Physical Victimization Effects |