Kizer K W, Vassar M J, Harry R L, Layton K D
Department of Community and International Health, University of California, Davis, School of Medicine, USA.
JAMA. 1995 Jun 14;273(22):1768-73.
To quantify the actual cost of inpatient medical care for firearm-related injuries at a university trauma center.
Retrospective case series of all hospital admissions for firearm-related injuries for the 3 years 1990 through 1992. Total inpatient financial data were examined by means of a recently instituted cost-accounting methodology.
Level I trauma center at a university hospital that provides trauma care and tertiary care to 3.7 million residents of 23 counties.
A total of 787 consecutive patients were admitted to the hospital with firearm-related injuries. Information from the trauma registry and hospital finance records were linked for 750 (95%) of these patients.
Total inpatient hospital charges, costs, revenues, and net income according to payer source.
Men aged 15 to 44 years accounted for 77% of patients with firearm-related injuries. The overall mean and median hospital charges per admission were $52,271 and $28,033, respectively, whereas the overall mean and median hospital costs per admission were $13,794 and $7964, respectively. The net income per patient ranged from an average loss of $6980 for each patient having no insurance to an average profit of $28,557 for each patient with a health maintenance organization contract. The losses sustained on nonsponsored and Medicaid patients were more than offset by net income from patients having private health insurance, Medicare, or other insurance coverage such that there was an average profit of $5809 per admission for a firearm-related injury.
Treatment of firearm-related injuries produces net income for this university trauma center by virtue of the cost shifting built into its pricing structure. If data from this institution are extrapolated to the nation, then the actual cost of providing medical care for firearm-related injuries in the United States in 1995 is projected to be $4.0 billion. The majority of this cost will be paid indirectly by private health insurance.
量化某大学创伤中心治疗火器伤的住院医疗实际成本。
对1990年至1992年这3年间所有因火器伤入院治疗的病例进行回顾性病例系列研究。采用最近制定的成本核算方法对住院总财务数据进行审查。
一所大学医院的一级创伤中心，为23个县的370万居民提供创伤护理和三级护理。
共有787例因火器伤连续入院的患者。其中750例（95%）患者的创伤登记信息与医院财务记录相关联。
根据付款方来源统计的住院总费用、成本、收入和净收入。
15至44岁男性占火器伤患者的77%。每次入院的总体平均和中位数住院费用分别为52271美元和28033美元，而每次入院的总体平均和中位数住院成本分别为13794美元和7964美元。每位患者的净收入范围从无保险患者平均亏损6980美元到有健康维护组织合同的患者平均盈利28557美元。非赞助患者和医疗补助患者的亏损被私人医疗保险、医疗保险或其他保险覆盖患者的净收入所抵消，以至于火器伤每次入院平均盈利5809美元。
由于该大学创伤中心定价结构中的成本转移，治疗火器伤为其带来了净收入。如果将该机构的数据外推至全国，那么预计1995年美国治疗火器伤的医疗护理实际成本为40亿美元。其中大部分成本将由私人医疗保险间接支付。
