Abstract
Background
Investment in violence prevention programs is hampered by lack of clearly identifiable
stakeholders with a financial stake in prevention. We determined the total annual
charges for the acute care of injuries from interpersonal violence and the shift in
financial responsibility for these charges after the Medicaid expansion from the Affordable
Care Act in 2014.
Methods
We analyzed all emergency department (ED) visits from 2009 to 2014 with diagnosis
codes for violent injury in the Nationwide Emergency Department Sample (NEDS). We
used sample weights to estimate total charges with adjusted generalized linear models
to estimate charges for the 15% of ED visits with missing charge data. We then calculated
the share attributable by payer and determined the difference in proportion by payer
from 2013 to 2014.
Results
Between 2009 and 2013, the uninsured accounted for 28.2–31.3% of annual charges for
the acute care of violent injury, while Medicaid was responsible for a similar amount
(29.0–31.0%). In 2014, there were $10.7 billion in total charges for violent injury.
Medicaid assumed the greatest share, 39.8% (95% CI: 38.0–41.5%, $3.5–5.1 billion),
while the uninsured accounted for 23.6% (95% CI: 22.2–24.9%, $2.0–3.0 billion), and
Medicare accounted for 7.8% (95% CI: 7.7–8.0%, $0.7–1.0 billion).
Conclusion
After Medicaid expansion, taxpayers are now accountable for nearly half of the $10.7
billion in annual charges for the acute care of violent injury in the U.S. These findings
highlight the benefit to state Medicaid programs of preventing interpersonal violence.
Keywords
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Article Info
Publication History
Published online: March 28, 2018
Accepted:
March 27,
2018
Received in revised form:
March 27,
2018
Received:
February 13,
2018
Identification
Copyright
Published by Elsevier Inc.
