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This chapter begins by examining the annual costs of medical treatment resulting from gunshot wounds. It evaluates the effect of gunshot injuries on the nation's total annual medical bill, as well as on the nation's medical system.

A significant body of research documents the volatility of household income and assets over the life cycle. The US bankruptcy system is among the policy interventions designed for such disruptions, and several million people pass through this system every year. Measures of homeownership, occupational prestige, and education indicate that they generally are middle class but have very low incomes when they file. This chapter examines the literature on medical problems among bankruptcy filings. It then explores the credit and debt management choices made by financially strapped households before they take the ultimate step of filing for bankruptcy. It focuses particularly on the management of medical bills not covered by insurance. The authors use data from the 2007 Consumer Bankruptcy Project, a nationally representative data set based on court records, written questionnaires, and telephone surveys.

This chapter explores medical bankruptcy, which is a much-debated topic, with most questions focused on exactly how many people file for it and how often it occurs. In 2005, Elizabeth Warren and her colleagues found that medical costs led to over 40% of bankruptcies in the United States. This was followed by an update in 2009, pushing the proportion of bankruptcies due to medical expenses to 62%. The Consumer Financial Protection Bureau’s 2014 report conflicts with this causal attribution, citing that less than 1% of adults in the United States file for bankruptcy, even though 20% of the population has great medical debt. In 2018, a group of economists reexamined this issue, concerned that the discrepancies in statistics were causing a misunderstanding of the problem. Their findings show an increase in people filing for bankruptcy after hospitalization. The researchers suggest that paying for medical bills out of pocket and losing income because of missed work are key reasons people file for personal bankruptcy. Ultimately, one thing is clear: the better people understand the causes of medical bankruptcy, the easier it is to see that an investment in disease prevention could boost Americans’ financial health, as well as their physical and mental well-being.

SBIRT (screening, brief intervention, and referral to treatment) is a comprehensive and integrated public health approach that aims to address hazardous and harmful substance use in patients through universal screening for substance misuse risk and the subsequent delivery of appropriate evidence-based interventions to reduce this risk. SBIRT has been implemented throughout all 50 states in a wide variety of medical settings. Thus far, over one million people across the country have been screened for substance use using SBIRT practices. SBIRT has also been implemented internationally. SBIRT is predicated on the premise that, like other chronic diseases, substance use falls along a clinical spectrum ranging from low to high risk. Patient substance use can be stratified across increasing risk levels that correlate with an appropriate disease state extending from abstinence to a diagnosable substance use disorder. Implications for treatment and prevention programs are discussed.