The financial cost of hospital and community violence

A new study assesses the financial impact of violence in hospitals and their communities, finding that the issue amounts to a multibillion-dollar problem annually.

Estimated costs total $18.27 billion per year, according to a report published June 2 by the American Hospital Association (AHA). The largest share of that total, $13.1 billion, is the amount spent on treatment of fatal and nonfatal injuries, with the costs falling on hospitals because patients are uninsured or because Medicare and Medicaid do not fully cover costs.

Other reported costs, totaling several billion dollars, arise as hospitals prepare for and respond to incidents of violence in healthcare settings.

The financial considerations represent one area of concern regarding what some in the healthcare industry have described as an epidemic of violence. According to Bureau of Labor Statistics data, workers in the combined healthcare and social assistance sector sustain 73% of nonfatal workplace-violence injuries that necessitate time away from work. Anecdotally, the issue appeared to get worse during the COVID-19 pandemic and has not improved measurably since.

Notably, costs have spiked since the AHA issued a 2016 report that found $2.7 billion in annual violence-related costs. Likely reasons for the nearly sevenfold difference include an increase in violent incidents and a more expansive definition of violence and associated cost components in the new report.

The report was conducted on behalf of the AHA by the University of Washington’s Harborview Injury Prevention and Research Center. Findings were derived from estimates of potential costs using statistical analyses. The analysts acknowledged that many calculations are partially based on assumptions, given limits in available data.

Costs of preparations

Hospitals and health systems spent $1.4 billion on training costs in 2023, according to the report, including roughly $377 million on de-escalation techniques, $369 million on emergency and medical surge preparedness, and $262 million on violence-related policies and procedures.

They also spent more than $400 million on security staffing, according to the analysis, which estimated that roughly 18% of industrywide spending on security staffing is linked to local crime rates.

Hospitals also spent more than $270 million to implement programs that provide holistic support for patients who arrive in the trauma unit as a result of violence, and nearly $700 million to install prevention programs that mitigate the risk of on-site violence through steps such as risk assessment, policies and procedures for reporting violent incidents, and incident-response planning.

Significant costs, estimated at $306 million, arose from facility modifications to address the potential for harm, with the report’s analysts pegging such modifications at 50% of total capital budgets. Technology investments to monitor for violent events cost $459 million.

Costs of responses

In addition to spending billions per year on treating injuries resulting from violence, hospitals pay substantial sums when violence takes place on-site and their employees have to miss time or possibly leave the job. That comes out to an estimated $79 million per year.

“This is likely to be an underestimate and does not account for reduced productivity or time loss due to untreated elements of injury, such as psychological harm, work missed due to post-traumatic stress disorder or unreported injuries,” the report states.

Even higher costs result from the impact on staff who are not directly involved in the violence but still are vulnerable to increased rates of absenteeism, turnover and loss of productivity. The last of those issues may also contribute to poor patient outcomes. Combined, these staffing issues totaled more than $540 million in costs during the study year.

Violence in hospitals also may require footing the bill for replacement infrastructure and equipment, costing an estimated $584 million annually. The vast majority of that amount ($565 million) was borne by metropolitan hospitals, according to the analysis.

The ramifications of violence extend far beyond costs, the report’s analysis notes: “Healthcare workers who experience or witness violence can experience many psychological impacts that affect their well-being as well as impact the health system. These psychological impacts lead to reduced workplace satisfaction and productivity, and recruitment and retention challenges, further impacting the burden of violence to hospitals.”

Tackling the problem

To combat violence that takes place in hospitals, bipartisan legislation introduced in both houses of Congress this year would set criminal penalties under federal law, including a prison sentence of up to 10 years, for assaulting hospital employees or anyone contracted to work at a hospital.

A prison sentence of up to 20 years would be authorized for any assault involving a deadly or dangerous weapon or causing bodily injury, or for committing an assault while a public health emergency is in place.

The legislation also would create a federal grant program, which would award up to $25 million over 10 years for protective technology and infrastructure such as access controls, video surveillance, metal detectors, panic buttons, status-alert systems, and safe patient and staff rooms.

The grants also would fund training of hospital personnel to prevent violence or intimidation through de-escalation tactics and responses to mental health crises.

Although the legislation has widespread support in both parties and is not prohibitively expensive, a similar House bill did not receive a vote even at the committee level after being introduced in 2023.

More than a dozen states have laws intended to protect healthcare employees from workplace violence, mostly in the form of requirements for employers.

“With the increase in violent events within clinical settings across the country, the resources needed to protect hospital workers and care for victims [have] grown exponentially,” Rick Pollack, president and CEO of the AHA, said as part of a written statement.