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Abstract
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The health case for reducing firearm injuries is clear--more than 45 000 US deaths1 and likely twice as many nonfatal firearm injuries occurred in 2020, the tip of an iceberg of physical and mental anguish. The moral case for reducing firearm injuries is clear--more children and adolescents in the US now die from firearm injuries than from any other cause, an injustice to innocent lives.2 The legal case for reducing firearm injuries is contentious, although familiar to many--an ongoing tension between a spectrum of opinions related to the Second Amendment.
But the business case for reducing firearm injuries has remained largely neglected. This is especially true for US companies whose revenues, together with their workers' wages, pay for the health care of employees and dependents who sustain firearm injuries.
The total economic toll of firearm injuries in the US is estimated to be $557 billion annually or 2.6% of gross domestic product, 88% of which is attributed to quality-of-life losses among those injured by firearms and among families.3 Even though this staggering macro-level figure is moving from a societal view, it can be difficult for individual employers to discern how much of this cost they bear and whether mitigating firearm injuries is actionable given their opportunity costs. About 21% of patients who present with nonfatal firearm injuries have private insurance, another 28% have Medicare or Medicaid, and the remainder are mostly uninsured.4
Recent Evidence for Employers
Among US workers and retirees with employer-sponsored health insurance, each nonfatal firearm injury leads to an estimated $30 000 in direct health care spending per survivor in the first year alone.5 This represents a 4-fold increase in health care spending from baseline, relative to workers of nearly identical age, sex, clinical factors, insurance characteristics, and areas of residence who did not sustain firearm injuries.
This additional spending on medical care is merely the preamble of employer costs. It does not include revenue losses, productivity losses, spending on employee assistance, spending on disability, or health care spending beyond the first year. For example, losses in revenue and productivity are estimated to cost employers $535 million per year nationwide.3 Despite that, the direct first-year medical spending on a firearm injury likely already exceeds the average first-year spending on other common conditions that employers have long tried to prevent, such as nonfatal myocardial infarction and heart failure.
Aside from added spending, employers face the physical and mental sequela of firearm injuries among their workforce. On average, workers who survive firearm injuries experience a 40% increase in pain, a 51% increase in psychiatric disorders, and an 85% increase in substance use disorders.5 Moreover, because employers generally insure workers and their family members, companies are similarly affected by a 25% increase in health care spending among family members during the month after an employee's firearm injury and a 12% increase in psychiatric disorders among family members during the first year.5 All of this does not include any spending on prescription drugs--notably medications to treat pain and psychiatric conditions, for which utilization increased by 30% and 9%, respectively, among firearm-injury survivors in the first year.5
Such evidence suggests that employers and their health insurers sustain a potentially substantial financial burden from firearm injuries and have a financial incentive to prevent them. To date, however, US businesses have by and large not engaged publicly on the subject of firearms despite spending large sums on other efforts to promote employee health.
US Employers and Health Care
Over the last 2 decades, the share of US workers with employer-sponsored coverage whose employers are self-insured (rather than a third-party insurer bearing the risk of workers needing health care) increased from about 40% to roughly 60%. Moreover, about 80% of workers in large companies with 1000 or more employees are now in self-insured plans.6 For these self-insured workers, health care spending comes out of their employers' margins, and is ultimately reflected in wages foregone. For other workers, mostly those in smaller businesses insured by private insurers, their health care spending, while partly borne by the insurer, is also eventually passed on to employers and employees in the form of higher premiums and lower wages...
Language: en |