The economic dimensions of interpersonal violence - libdoc.who.int ...

2. COSTS OF INTERPERSONAL VIOLENCECalifornia Medical Center found that 87% of the costs of treating gunshotwounds of the trunk were paid with public funds - with average hospital stays of6.8 days and costs of $10 600 per patient (Payne et al., 1993). Similarly, 80% ofthe direct medical costs for gunshot wounds, stab wounds and injuries fromassault at the San Francisco General Hospital in the mid-1980s were paid forwith public funds (Sumner, Mintz & Brown, 1987). In a study of gunshot andstabbing wounds in a metropolitan trauma centre in Los Angeles county inCalifornia, the total collection rate for direct medical expenses - averaging$4 701 per case - was just 22% (Klein et al., 1999). Overall, in the USA, eachgunshot victim generated an estimated average of $9 209 in uncompensatedcosts (Physicians for Social Responsibility, 2002).There is similar but less well-documented evidence of the effect of other typesof interpersonal violence on public finances. Of the costs of medical care andlegal fees for burns suffered by child abuse victims in a study in Ohio, 65% werepaid with public funds (Evasovich et al., 1998). Clancy et al. (1994) found that70% of hospital charges for patients with assault-related penetrating injuries ata major medical centre in North Carolina were not reimbursed. Gunderson(1999) reported that 85% of the medical care costs of gun violence victims inthe USA was paid from public sources.There are fewer figures available internationally concerning the impact ofviolence on public financing. Most high-income countries have a higherpercentage of public financing for health care in general than the USA where45% of health care costs were paid with public funds (World Bank, 2003). It istherefore likely that the corresponding contribution of the public sector to thecosts of violence was higher in these countries than in the studies from the USAcited above.In low- and middle-income countries, it is also probable that society in generalabsorbs much of the costs of violence. One study in Jamaica found that 90% ofthe costs of treating victims of violence at the Kingston Public Hospital -including materials, drugs and doctors' fees - were paid by the government(Mansingh & Ramphal, 1993).27