Lessons From Analyzing the Medical Costs of Civilian Terror Victims: Planning Resources Allocation for a New Era of Confrontations

• Published in: The Milbank quarterly Vol. 95; no. 4; pp. 783 - 800
• Main Authors: ELLENBERG, EYTAN, TARAGIN, MARK I., HOFFMAN, JAY R., COHEN, OSNAT, LUFT-AFIK, DANIELLA, BAR-ON, ZVIA, OSTFELD, ISHAY
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.12.2017; Blackwell Publishing Ltd; John Wiley and Sons Inc
• Subjects: Allocation; Ambulatory Care - economics; Ambulatory Care - statistics & numerical data; Casualties; Chi-square test; Civilians; Claims; Compensation; Conflict; Cost analysis; Costs; Crime Victims - economics; Crime Victims - statistics & numerical data; Demography; Disability pensions; disaster; Evolution; Expenditures; First year; Health care; Health Care Costs - statistics & numerical data; Health care expenditures; Health care policy; Health insurance; Health services; Hospitalization; Hospitalization - economics; Hospitalization - statistics & numerical data; Humans; Israel; Medical devices; Medical equipment; Medical supplies; Medicine; Mental health; Mental health services; Mental Health Services - economics; Mental Health Services - statistics & numerical data; National insurance; Original Investigation; Original Investigations; Pensions; Planning; Population (statistical); post–health services; Public health; Rehabilitation; Rehabilitation Centers - economics; Rehabilitation Centers - statistics & numerical data; Resource allocation; Responses; Spacecraft components; Specialists; Statistical analysis; Statistical tests; Stress; Stresses; Students; Terrorism; Terrorism - economics; Terrorism - statistics & numerical data; Threats; Victims; War; Warfare; war; post-health services; terrorism; disaster
• ISSN: 0887-378X; 1468-0009
• DOI: 10.1111/1468-0009.12299

Context: Across the globe, the threat from terrorist attacks is rising, which requires a careful assessment of long-term medical support. Based on an 18-month follow-up of the Israeli civilian population following the 2014 war in Gaza, we describe and analyze the medical costs associated with rocket attacks and review the demography of the victims who filed claims for disability compensation. We then propose practical lessons to help health care authorities prepare for future confrontations. Method: Using the National Insurance Institute of Israel's (NII) database, we conducted descriptive and comparative analyses using statistical tests (Fisher's Exact Test, chi-square test, and students' t-tests). The costs were updated until March 30, 2016, and are presented in US dollars. We included only civilian expenses in our analysis. Findings: We identified 5,189 victims, 3,236 of whom presented with acute stress reactions during the conflict. Eighteen months after the conflict, the victims' total medical costs reached $4.4 million. The NII reimbursed $2,541,053 for associated medical costs and $1,921,792 for associated mental health costs. A total of 709 victims filed claims with the NII for further support, including rehabilitation, medical devices, and disability pensions. Conclusion: We found 3 major sources of costs: hospital expenditures, mental health services dedicated to acute stress reactions, and ambulatory follow-up. During the first year, most of the costs were related to hospitalization and support for stress relief. During the second year, ambulatory and rehabilitation costs continued to grow. Public health specialists should consider these major components of costs and their evolution over time to properly advise the medical and social authorities on allocating resources for the medical and nonmedical support of civilian casualties resulting from war or terror.