Cost of Community Violence to Hospitals and Health Systems

Violence in our communities is a serious public health issue, and as such, it is of great concern to hospitals that care for victims of violence and also prepare for possible mass events. While a review of prior research shows that numerous efforts from a range of perspectives have been made to quantify the impact of violence to various stakeholders, a comprehensive estimate of the financial impact to community healthcare resources, specifically hospitals and health systems, has not been accomplished. The American Hospital Association (AHA) has engaged Milliman to conduct a study of the financial impact to hospitals and health systems of dealing with all types of violence within their facilities and communities to better illustrate the enormity of violence as a public health problem. For the purposes of this study, we define violence broadly, to include any intentional use of physical force to cause injury or bodily harm. This report presents the findings of our research.

Hospitals provide critical and lifesaving services to victims of violence within their communities, and also address violence beyond medical care. As key community stakeholders in antiviolence efforts, hospitals engage in prevention and preparedness activities, both to address the determinants of violence within their communities, and to be capable of responding appropriately when violence does occur. Further, healthcare workers face an increased risk of both physical and verbal abuse as they manage the complex needs of patients and visitors within their facilities. Many patients and visitors experience high-stress, emotionally charged situations during their time in the hospital that can sometimes lead to aggressive behavior. As such, hospitals and health systems make significant investments in infrastructure, staff, and training in order to keep their workers, patients, and visitors safe.

In reading this report, it is important to recall that the term “cost” can mean different things to different stakeholders, especially with regard to healthcare. To providers, including hospitals, the “cost” of healthcare is the investment in resources that support the provision of healthcare services to their patients, and this can include direct patient care as well as indirect costs for ancillary functions that support their overall operations. Throughout this report, we examine costs from the viewpoint of hospitals and health systems, identifying the expenditures and resource needs involved in responding to violence within their communities and workplaces.

To quantify the tremendous resources put toward caring for victims of violence and anticipating violent events, we divided costs into the following categories:

• Public violence: Prevention and preparedness costs (proactive).
• Public violence: Post-incident costs (reactive).
• In-facility violence: Prevention and preparedness costs (proactive).
• In-facility violence: Post-incident costs (reactive).

Overall, we estimated that proactive and reactive violence response efforts cost U.S. hospitals and health systems approximately $2.7 billion in 2016. This includes $280 million related to preparedness and prevention to address community violence, $852 million in unreimbursed medical care for victims of violence, $1.1 billion in security and training costs to prevent violence within hospitals, and an additional $429 million in medical care, staffing, indemnity, and other costs as a result of violence against hospital employees.