departments). The table below shows the hospitalisation costs of these patients.
| Table
29: Cost of Firearm Injuries
by Hospitalisation Requirement in 1993 (in SA Rands) |
|||
| Hospitalisation Requirement |
N | Mean hospital cost per patient per day (or visit) | Total Cost |
| Discharged | 352 | 223 | 78 496 |
| Died in trauma unit | 42 | 791 | 33 222 |
| Admitted ICU | 48 | 18 289 | 877 872 |
| Admitted to hi care | 30 | 4 990 | 149 700 |
| Admitted to ward | 495 | 5 551 | 2 747 745 |
| Absconded | 2 | 94 | 188 |
| TOTAL | 969 | R4 012 | R3 887 223 |
The total figure is probably an underestimation of the true amount since the costs are based on the average cost per patient per day for all patients in the hospital but surgical patients are generally more expensive to treat than medical patients. In this study, 42% of patients with firearm-related injuries required surgery. At King Edward VIII Hospital in 1997, 66% of patients with firearm injuries had to be operated on.3 Furthermore, the above figure only accounts for acute care; the long-term management or rehabilitation costs are not included.
A second reason for the high cost of firearm injuries involves the profile of the victims. The majority of those injured or killed are economically active young males. Hence, not only are firearm injuries a financial burden in terms of the direct expenditure on health care, but also because of lost productivity as a result of temporary/permanent disability or premature death. Economists in the United States have pointed out that medical costs contribute only 13% to the total cost of firearm injuries to society, the remaining 87% comes from the lost productivity.8 Although one should not apply USA data in South Africa (because we have a very different socio-economic structure), if the above proportions were used in the above study the composite costs for the 969 patients would amount to R29 697 315 per annum. This is for one hospital only and this figure was calculated as 1993 Bands.
In a 1997 study, Phillips9 calculated the indirect cost of firearm homicides in the Cape Metropole as between 12 and 47 million rands per annum. These figures reflect the value of lost productivity, but exclude the costs of perpetrator control/imprisonment and the costs related to victim and perpetrator medical care.
The escalating number of firearm injuries are swamping emergency services and overloading hospital facilities. Since many patients can not afford the fees, the state bears most of the cost for firearm injuries, including expensive surgery.3 Measures to prevent and control these injuries and deaths are urgently required.
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