The Expense of Community Violence

Community violence has many costs associated with it.  The toll taken on the physical health of the victim is perhaps the most obvious, but the emotional health of the victim and their friends and family is also threatened, and indeed, the sense of well being in the community at large also has the possibility of being diminished.  One of the less frequently considered costs of community violence is the fiscal cost borne by the healthcare system of that community, and a recent report by the American Hospital Association indicates that the U.S. healthcare system spent 2.7 billion dollars in 2016 on proactive and reactive violence response efforts.

The report, entitled, Cost of community violence to hospitals and health systems, was produced by Milliman Inc. for the American Hospital Association, and conducts

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.

The goal of the study, then, was not only to highlight the exceedingly high cost of community violence to the healthcare system, but also to indicate just what an enormous public health issue community violence really is.  The study broke the costs of community violence into four categories: [1] Public violence: Prevention and preparedness costs (proactive); [2] Public violence: Post-incident costs (reactive); [3] In-facility violence: Prevention and preparedness costs (proactive); [4] In-facility violence: Post-incident costs (reactive). Category 1 (public violence, proactive) accounted for 279.5 million dollars, Category 2 (public violence, reactive) accounted for 852.2 million dollars of expenditure, Category 3 (in-facility violence, proactive) cost 1.1 billion dollars, and Category 4 (in-facility violence, reactive) cost 428.5 million dollars, totaling 2.7 billion dollars spent in 2016.

Perhaps the most surprising expenditure highlighted by the report was the cost of security staff and infrastructure, which was categorized as an “In-facility violence: Prevention and preparedness cost (proactive)” category 3 expenditure that cost a total of 846.7 million dollars in 2016, accounting for 31.6% of the total cost of community violence for the year.  Other notable costs were for uncompensated or under compensated care (a category 2 expenditure), which cost a total of 752.4 million dollars in 2016, or 28.1% of the total, and staff turnover (a category 4 expenditure) which cost 234.2 million dollars, or 8.7% of the total costs of community violence for 2016.  These three expenditures alone account for nearly 70% of all the costs of community violence, though interestingly, none of them relate to the prevention of public violence (category 1), which was the category of least expenditure in 2016.

Clearly, the physical, emotional, and fiscal costs of community violence are prohibitive, and perhaps this report from the American Hospital Association will further motivate communities and their healthcare systems to continue to work toward the elimination of community violence, and all the costs that come with it.