Million Dollar Baby

Okay, okay, maybe not a million, but having a baby in the United States will certainly cost you a pretty penny these days! A recent article published in the New York Times, American Way of Birth - Costliest in the World looked at the reasons why Americans shell out so much money for both prenatal care and delivery and how it compares to other areas of the world where costs are drastically lower.

"Childbirth in the United States is uniquely expensive, and maternity and newborn

care constitute the single biggest category of hospital payouts for most commercial insurers and state Medicaid programs." [1]

A recent statistic published by Truven Health Analytics showed that delivery charges in the United States have nearly tripled since 1996, and out-of-pocket expenses have risen almost four-fold. With many women having to pay out-of-pocket for maternity care, either because of a lack of coverage or increased deductibles/co-payments related to maternity costs, this rise in cost plays a significant impact on millions of families in the United States. Even with insurance coverage, families are paying an average of $3400 for a normal vaginal birth. In the past, out-of-pocket expense was next to nothing, if anything at all for families with insurance coverage.

Average cost for pregnancy and newborn care for a normal vaginal birth = $30,000

Average commercial insurance coverage = $18,329

Average cost for pregnancy and newborn care for a cesarean birth = $50,000

Average commercial insurance coverage = $27,866

What makes maternity care in the United States so much more expensive than in other areas of the world? One of the biggest factors is the way in which services are charged. Over the past decade, services have become more and more individualized so that they are being charged in an a-la-carte fashion, rather than part of one lump sum. Almost all other developed countries charge women a flat fee for maternity care, regardless of individual healthcare choices by the mother. Rather than being billed for a wide array of different tests and hospital services, each pregnancy and delivery is viewed through the same financial lens. In the United States, the choices that you make (or your caregiver makes for you) with regards to your care will be very visible on your stack of bills that come piling in. The more tests and "extra servies" you receive, the higher your bill will be.

Despite the high costs of maternity care in the United States, our country still holds one of the highest rates of maternal death and infant mortality of an industrialized nation, as well as one of the highest rates of interventions.

What is being done as a response to these enormous costs? For starters, many hospitals are beginning to look at and adopt an all-inclusive rate for maternity care, with one flat fee for a vaginal birth and another for a cesarean section. The increased use of midwives would also allow for lowered costs, as seen in most other industrialized nations where midwives perform the bulk of prenatal appointments and deliveries, keeping costs down and interventions low. In these countries, obstetricians step in only in emergencies or situations where a specialist is needed. In the United States, mothers may opt for maternity care with a midwife outside of the hospital (either at a birth center or at home), and often pay a fraction of the cost of hospital birth without all of the bills and insurance hassles. However, these types of birth experiences are still hard to come by in the United States where many women's only option is that of the classic hospital birth accompanied by an OBGYN.

This information seems to scream out the point that many Americans have been trying to get across for so long - medicalized maternity care does not necessarily mean a better and safer birth experience. In fact, it seems that the more medicalized our mindset and practices surrounding maternity care become, the greater the rate of complications and interventions and the higher the costs of care become.

Action items for those families expecting a child:

1) Call your insurance company and find out what services they will/will not cover

2) Educate yourself and talk to your caregiver about what tests and procedures are necessary during pregnancy and labor

3) Search out various caregiver and birthplace options available to you

4) If possible, begin saving money towards potential pregnancy and birth costs

5) Above all, become informed about maternity care where you live and take action to provide a safer and more affordable birth experience for others

[1] Rosenthal, Elisabeth. "American Way of Birth, Costliest in the World." New York Times 30 June 2013. Web. 07 July 2013. <http://www.nytimes.com/2013/07/01/health/american-way-of-birth-costliest-in-the-world.html?_r=0>.

#finances #costofchildbirth