U.S. hospitals spent an estimated $18.3 billion in 2023 responding to or preventing violence, according to a new analysis from the American Hospital Association (AHA).
That total includes violence affecting patients and healthcare workers both in a facility or in a health system’s broader community.
This includes $3.6 billion of “pre-event efforts” such as workers’ violence preparation training ($1.4 billion), security personnel and related staffing ($404 million), monitoring technology investments ($459 million) and other facility modifications related to preventing or mitigating violence ($306 million).
The lion’s share of the report’s (PDF) top-line number, almost $13.2 billion, is tied to treatment for injuries stemming from community violence among patients who were uninsured or whose public insurance coverage pays hospitals less than the cost of care. Here, an estimated 23.6% of all violence-related injuries treated by hospitals and EDs were among uninsured patients, while 39.8% were insured by Medicaid and 7.8% were insured by Medicare.
Other “post-event financial costs” borne by hospitals included those related to the healthcare workforce, which national data suggest bore about three-quarters of all U.S. nonfatal violence-related occupational injuries and illness even before a pandemic escalation.
Among these was an estimated $79 million related to healthcare workers missing work following injury due to violence, which was considered “likely to be an underestimate.”
The analysis also suggested $541 million of staffing-related costs for hospitals tied to the nonphysical effects of violence exposure, such as emotional trauma, stress, burnout and decreased morale. This stemmed from a $139 million annual loss due to a rise in employee absenteeism attributed to nonphysical outcomes like emotional trauma and stress, $184 million due to worsened employee productivity following exposure to violence and $218 million due to increased turnover.
The report was put together for the AHA by the University of Washington School of Medicine’s Harborview Injury & Prevention Research Center.
Its authors warned that, due to limited published literature, most of the cost calculations include “largely conservative” assumptions that could make the true burden higher than the estimates. They also outlined several other impacts of violence that could not be given reliable financial estimates, such as legal costs, “compassion fatigue,” employee satisfaction and post-traumatic stress disorder.
In a statement, AHA President and CEO Rick Pollack described violence against care workers as “an unacceptable reality” and the report as “yet another reminder” that more must be done.
“We know the enormous human and emotional toll violence takes on our communities and caregivers,” he said. “This report goes beyond that to break down the significant related financial costs incurred upon hospitals and health systems. With the increase in violent events within clinical settings across the country, the resources needed to protect hospital workers and care for victims has grown exponentially.”
The AHA’s statement also reiterated support for legislation introduced last month that would make assaulting an on-the-job hospital worker a federal crime, the Save Healthcare Workers Act.
The report echoes prior findings from industry surveys of healthcare workers, such as a 2024 poll of nurses that found more than four in five had experienced workplace violence in the prior year.
A 2023 report from the Commonwealth Fund suggested that gun violence was responsible for $1 billion per year in initial ER visits alone, with substantial medical bills to follow. Former U.S. Surgeon General Vivek Murthy, M.D., declared firearm violence a public health crisis the following year.