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The High Cost of Giving Birth in the U.S.

The U.S. model encourages "more expensive care, rather than care that is good for the mother,” says one expert.
 
 
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Giving birth in the United States is far more expensive than in other countries, and the additional cost does not appear to come with additional benefits — Americans do not have more access to care or better access to care than citizens in other developed nations, according to an  analysis from the New York Times.

“It’s not primarily that we get a different bundle of services when we have a baby,” Gerard Anderson, an economist at the Johns Hopkins School of Public Health who studies international health costs, told the Times. “It’s that we pay individually for each service and pay more for the services we receive.”

This is an unusual model among other countries, as the Times  notes:

Only in the United States is pregnancy generally billed item by item, a practice that has spiraled in the past decade, doctors say. No item is too small. Charges that 20 years ago were lumped together and covered under the general hospital fee are now broken out, leading to more bills and inflated costs. There are separate fees for the delivery room, the birthing tub and each night in a semiprivate hospital room, typically thousands of dollars. Even removing the placenta can be coded as a separate charge…

Add up the bills, and the total is startling. “We’ve created incentives that encourage more expensive care, rather than care that is good for the mother,” said Maureen Corry, the executive director of Childbirth Connection.

And the already high cost is going up, as the  analysis shows:

From 2004 to 2010, the prices that insurers paid for childbirth — one of the most universal medical encounters — rose 49 percent for vaginal births and 41 percent for Caesarean sections in the United States, with average out-of-pocket costs rising fourfold, according to a recent report by Truven that was commissioned by three health care groups. The average total price charged for pregnancy and newborn care was about $30,000 for a vaginal delivery and $50,000 for a C-section, with commercial insurers paying out an average of $18,329 and $27,866, the report found.

Women with insurance pay out of pocket an average of $3,400, according to a survey by Childbirth Connection, one of the groups behind the maternity costs report. Two decades ago, women typically paid nothing other than a small fee if they opted for a private hospital room or television.

Some hospitals are now offering package deals as an alternative to the fee per service model, including the Maricopa Medical Center in Phoenix, Az., which charges $3,850 for a vaginal delivery and $5,600 for a planned C-section, inclusive of doctor’s fees. It’s a model that progressive policy groups are hoping will be emulated elsewhere.

And new requirements under the Affordable Care Act will help more women access maternity coverage, which should help reduce the financial burden for more new mothers.

But lower costs may also require parents-to-be to manage expectations about what services are necessary for a safe pregnancy and birth, some experts say. As the analysis found, the bells and whistles of child birth in the U.S., including the presence of an obstetrician during every prenatal visit and other services rendered during so-called medicalized deliveries, are unusual among other developed countries, which rely more heavily on the services of midwives during prenatal examinations and births for uncomplicated and low-risk pregnancies.

“It’s amazing how much patients buy into our tendency to do a lot of tests,” Eugene Declercq, a professor at Boston University who studies international variations in pregnancy, told the Times. “We’ve met the problem, and it’s us.”

 
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