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American Way of Birth, Costliest in the World


Health & Wellness  (tags: Americans, child birth )

Kit
- 422 days ago - nytimes.com
Ms. Martin, 31, and her husband, Mark Willett, are both professionals with health insurance, her current policy does not cover maternity care



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Kit B. (277)
Monday July 1, 2013, 5:46 am
Photo Credit: Josh Haner/The New York Times



LACONIA, N.H. — Seven months pregnant, at a time when most expectant couples are stockpiling diapers and choosing car seats, Renée Martin was struggling with bigger purchases.

At a prenatal class in March, she was told about epidural anesthesia and was given the option of using a birthing tub during labor. To each offer, she had one gnawing question: “How much is that going to cost?”

Though Ms. Martin, 31, and her husband, Mark Willett, are both professionals with health insurance, her current policy does not cover maternity care. So the couple had to approach the nine months that led to the birth of their daughter in May like an extended shopping trip though the American health care bazaar, sorting through an array of maternity services that most often have no clear price and — with no insurer to haggle on their behalf — trying to negotiate discounts from hospitals and doctors.

When she became pregnant, Ms. Martin called her local hospital inquiring about the price of maternity care; the finance office at first said it did not know, and then gave her a range of $4,000 to $45,000. “It was unreal,” Ms. Martin said. “I was like, How could you not know this? You’re a hospital.”

Midway through her pregnancy, she fought for a deep discount on a $935 bill for an ultrasound, arguing that she had already paid a radiologist $256 to read the scan, which took only 20 minutes of a technician’s time using a machine that had been bought years ago. She ended up paying $655. “I feel like I’m in a used-car lot,” said Ms. Martin, a former art gallery manager who is starting graduate school in the fall.

Like Ms. Martin, plenty of other pregnant women are getting sticker shock in the United States, where charges for delivery have about tripled since 1996, according to an analysis done for The New York Times by Truven Health Analytics. 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. The cumulative costs of approximately four million annual births is well over $50 billion.

And though maternity care costs far less in other developed countries than it does in the United States, studies show that their citizens do not have less access to care or to high-tech care during pregnancy than Americans.

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

.


Those payment incentives for providers also mean that American women with normal pregnancies tend to get more of everything, necessary or not, from blood tests to ultrasound scans, said Katy Kozhimannil, a professor at the University of Minnesota School of Public Health who studies the cost of women’s health care.

Financially, they suffer the consequences. In 2011, 62 percent of women in the United States covered by private plans that were not obtained through an employer lacked maternity coverage, like Ms. Martin. But even many women with coverage are feeling the pinch as insurers demand higher co-payments and deductibles and exclude many pregnancy-related services.

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.
****

BY: Elisabeth Rosenthal | The New York Times |
 

Kit B. (277)
Monday July 1, 2013, 5:53 am

We forget that an OB/GYN is a trained surgeon, and not trained in the "art" of delivering a baby. One of the reasons we do have such a high rate of C-sections, doctors tend to follow their training. The cost of having a baby should outrage all Americans, this is not a luxury but rather an essential of women's health care.
 

JL A. (275)
Monday July 1, 2013, 7:12 am
I'm also outraged about some denials of services covered given that Carter's Executive Order required coverage like all other health conditions.
 

Arielle S. (317)
Monday July 1, 2013, 11:38 am
Again, women become discriminated against.... but then, insurance used to be insurance. Now home polices don't cover flooding - or hurricanes - or earthquakes. And apparently, the most obvious of health insurance needs are not met either! This was news to me - I had been assuming having a baby covered under insurance was uncontested, accepted, and expected - silly me.
 

Kit B. (277)
Monday July 1, 2013, 11:50 am

My son was born in 1975, we didn't have insurance. The whole bill was $400.00.

Now as this article illustrates, that's not even an down payment.
 

Jane K. (10)
Monday July 1, 2013, 12:19 pm
I used to work for some insurance companies and believe me they are in the business of not paying. Anything they can deny you is money in their pockets so what do you think they strive to do ? I love the smug people in this country who say, I have insurance and it's you're fault if you have problems . They are in for a rude awakening if something bad ever does happen to them, you THINK you have insurance and pay through the nose for coverage you THINK you have until the denials of care or payment start coming. We need Universal coverage and a single payer system to remove all profit from health care. It is the only way to insure you will have the health care you need and won't have to go bankrupt for it. Other countries do it just fine but the US is ruled by corporations and they do a good job of convincing people that what we have now is the only way to go. It isn't, it's bad for us and we need to demand a change.
 

Kit B. (277)
Monday July 1, 2013, 12:25 pm

Alright Jane! We do need universal healthcare. The ACA is is a slight improvement but not the final fix.
 

Deborah W. (6)
Monday July 1, 2013, 1:34 pm
Think covered, uncovered, or partially covered are set in stone (and already of of wack), wait until Obamacare gets going full throttle.
 

Alice C. (1797)
Monday July 1, 2013, 1:42 pm
Good information ~ Thank you ~ I'm happy that I was able to pay for the birth of my 2 children.
 

Alice C. (1797)
Monday July 1, 2013, 1:43 pm
Shared
 

Kathy Niell (95)
Monday July 1, 2013, 2:18 pm
With such high costs, you wouldn't expect the U.S. to have the highest infant mortality rate of the industrial countries, but it does. Go figure!
 

Birgit W. (144)
Monday July 1, 2013, 4:20 pm
This is outrageous. Why would the US government not be interested in paying for the safe birth of their new citizens?
 

Lois Jordan (54)
Monday July 1, 2013, 4:32 pm
Thanks, Kit. The more of the article I read, the more shocked I became. I had my first in 1975, too, and the bill was minimal--like Kit's was. I had no ultrasound at that time because they were fairly new, and there was much contention that ultrasounds hurt the future hearing of the fetus. By 1991, when I had my last, ultrasounds were commonplace and insisted upon. Although covered by insurance, (or maybe because I WAS covered), many tests were insisted upon, although I protested. My protests caused my OB to tell me he couldn't continue to be my doctor without them.
So, now some 20 yrs. later it is appalling to read the prices charged by OB's and hospitals. So many OB's today seem to prefer scheduled C-SEC's, for no reason other than it's more convenient for them, plus costlier.
 

Jennifer C. (172)
Monday July 1, 2013, 5:09 pm
Noted.
 

Eternal Gardener (734)
Monday July 1, 2013, 5:15 pm
Unbelievable! Is this a covert way of schemed population control...playing with lives for money?
 

marie Taylor clarke (166)
Monday July 1, 2013, 5:38 pm
Thank you Kit outrageous
 

Connie O. (42)
Monday July 1, 2013, 5:40 pm
I just read something in our newspaper that regular deliveries and maternity care costs $30,000 and c- sections $50,000. This is outrageous. They are doing unecessary tests just to run up the bill, as each item is billed separately. I guess a few places are offering a one-price-includes all package. Luckily I am past child bearing age, but my son is not....and without very good insurance, he would go into debt (if he ever decides to have any children).
 

Anne K. (128)
Monday July 1, 2013, 6:36 pm
Birth control is cheaper and better for the planet.
 

Wolfgang W. (197)
Monday July 1, 2013, 7:15 pm
Come get your child in germany and spend your money for a nice holiday!
 

Kit B. (277)
Monday July 1, 2013, 7:21 pm

Thank you, Wolfgang but I doubt the German people want to pay for American maternity. I think we need to clean up our own house and just take a holiday in Germany.
 

Julie E. (345)
Monday July 1, 2013, 7:37 pm
So many women are doing home births using midwives. I wonder how many of those women chose to do a home birth because of the hospital fee's?
My son was born in 1993 and cost me $5.00. That was the co-payment with the insurance I had.
Thanks for the article Kit!
 

Kit B. (277)
Monday July 1, 2013, 7:42 pm

Midwives are less expensive and for the majority of women home birth is perfectly safe, it is always wise to have the nearest hospital alerted just in case. I used a midwife for both of my children, but that was not a forced financial decision. I just can not believe how hospitals are gouging the public, this really must change.
 

Frances Darcy (218)
Tuesday July 2, 2013, 3:18 am
My God, I find this shocking ... here in Ireland it is free except if you opt to go private.
 

John Gregoire (255)
Tuesday July 2, 2013, 5:25 am
Also the trend towards Caesareans is aboslutely crazy and in contravention of good medical practice. Birthing centers and home biths with midwife attendance is a nice change from the "medical" setting.
 

Kit B. (277)
Tuesday July 2, 2013, 5:32 am

The national U.S. cesarean section rate was 4.5% and near this optimal range in 1965 when it was first measured (Taffel et al. 1987). Since then, large groups of healthy, low-risk American women who have received care that enhanced their bodies' innate capacity for giving birth have achieved 4% to 6% cesarean section rates and good overall birth outcomes (Johnson and Daviss 2005, Stapleton et al. 2013). However, the national cesarean section rate is much higher. After steeply increasing over more than a decade, it leveled off at 32.8% in 2010 and 2011 (Hamilton et al. 2012). So, about one mother in three now gives birth by cesarean section.

http://www.childbirthconnection.org/article.asp?ck=10456

The highest rates of Caesarean births were in New Jersey (38.3 percent) and Florida (37.2 percent), and the lowest were in Utah (22.2 percent) and Alaska (22.6 percent).
http://www.nytimes.com/2010/03/24/health/24birth.html?_r=0
 

Patricia H. (468)
Tuesday July 2, 2013, 8:23 am
noted
 

Jonathan Harper (0)
Tuesday July 2, 2013, 12:20 pm
noted
 

Deborah W. (6)
Tuesday July 2, 2013, 3:40 pm
Should impact our over-population problem ... and expand the abortion business. Only in AmeriKa.
 

Charlie Rush (53)
Tuesday July 2, 2013, 6:32 pm
If we permit the GOP to prevail in blocking Obama Care, we can start to see our costs become even greater. The saddest part of all, is that most people, still to this day, do not comprehend what it is all about. Add to that, the Republican Party is hell-bent of keeping our citizens from the merits it provides. They are sacred to death, that once, Americans can appreciate the benefits, they will never be able to get rid of it.

Guess what, about this one, THEY ARE RIGHT!

How can we consider ourselves world leaders, under our current circumstances? The rest of the world is laughing at us, behind our backs; in fact, that's no surprise.
 

Dandelion G. (386)
Tuesday July 2, 2013, 7:18 pm
Wow, I'm glad I had my children in the 80's. With the new measures of needing vaginal ultra sounds before one can obtain an abortion and now in Ohio has passed even to obtain birth control this is another added financial burden on many women. The section below speaks of ultra sounds and the cost, and these "forced" vaginal ultra sounds on women whether their Dr. feels it is necessary or not, whether the woman wants it or not or even so much as needs it, now is required to have at THEIR OWN EXPENSE.

Within the article:

Midway through her pregnancy, she fought for a deep discount on a $935 bill for an ultrasound, arguing that she had already paid a radiologist $256 to read the scan, which took only 20 minutes of a technician’s time using a machine that had been bought years ago. She ended up paying $655.

All I see is this is placing more financial ruin upon families that are already in struggle or just making it. Medical is the #1 reason for bankruptcy I don't see where this helps our citizens either financially nor medically. Curse those Heartless Ones who is pushing this. People, this is NOT the Republican Party of your Grandparents or even Parents.
 

Dandelion G. (386)
Tuesday July 2, 2013, 7:26 pm
PS....I fully agree we need Universal Health Care. This so called Health Care system is neither caring nor healthy.
 

Kit B. (277)
Tuesday July 2, 2013, 7:27 pm

But it is a compromise and that seems to be far more important than health or caring.

 

Kerrie G. (135)
Wednesday July 3, 2013, 1:22 am
Noted, thanks.
 

Sherri O. (257)
Wednesday July 3, 2013, 9:08 pm
I'm glad I'm Canadian. Our health services and coverages in Ontario are still pretty good.
 

John S. (300)
Thursday July 4, 2013, 5:08 am
I would have thought that the hospitals would have come up with some prepaid options (for the standard test), but when you tell me the price range is from 4,000 to 45,000 I assume there are some options that are not required. I also wonder how they will address the issue of maternal obesity which has to be one of the main drivers in the cost of medicine for maternity.
 

Rose NoFWDSPLZ (273)
Friday July 5, 2013, 4:54 pm
It is free in Australia
 

Laurie H. (706)
Tuesday July 9, 2013, 9:57 pm
I'm fortunate that I had my son in the early 70s and like Kit, paid around $400. It's crazy what costs have escalated to. It seems as though Canada's health care system, is perhaps not perfect, but not all that bad either. May be worth taking a second look. As mentioned, hospitals & may I add pharmacy's, along with many others, are taking advantage of the people. Much needs to change & fast! People are going without food to buy their medications, serious problems continue to exist. It's time for more assistance than just a lick & a promise. We're in a real "Health Care Crisis" in this country & something needs to be done, & NOW! Thanks So Much Kit!!!~
 

Sherri G. (111)
Wednesday July 10, 2013, 1:45 am
Having a baby in this country should not be so expensive the Mom and Dad can't afford to raise the child. What impact will Obama care have on the cost to have a baby if any Kit? TY Kit and Dandelion. Noted.
 

Susan Allen (221)
Wednesday July 10, 2013, 7:26 am
We need universal healthcare period; everything covered for everyone. Noted and shared.
 

Kit B. (277)
Wednesday July 10, 2013, 7:40 pm

Sherrie, As I understand the ACA will have wellness coverage which does apply to pregnant women, and:

Gestational diabetes screening that helps protect pregnant women from one of the most serious pregnancy-related diseases, breastfeeding support, supplies, and counseling.
But doctors and hospitals are still going to over charge and few know enough to find services beyond the standard health care.
We treat pregnancy as a disease, pregnant women are healthy an exception to most people that seek medical care. Some one needs to begin a revolution in how we treat this process.

 

Diane K. (136)
Wednesday July 10, 2013, 8:18 pm
This really isn't fair health insurance. I can't believe the exclusions! Discriminating against child birth costs, is not good policy, for sure. thanks for posting.
 

Kit B. (277)
Wednesday July 10, 2013, 8:23 pm

As much as many states are fighting to end abortion, why are those same people not fighting for fair and honest treatment of pregnant women?
 

Dandelion G. (386)
Thursday July 11, 2013, 5:32 am
Good question Kit, and once these children are born why do we leave them floundering around with a broken system. Children not getting enough food to eat, schools being closed, students in debt before they get going, then lack of living wage employment for many.

This whole system needs a good overhaul from top to bottom in my opinion. The only place I see the American Dream being played out is Finland.
 

Kit B. (277)
Thursday July 11, 2013, 11:24 am

Indeed,Dandelion Finland is an excellent example.
 

. (0)
Thursday July 11, 2013, 4:01 pm
TY Kit for the very true article. I know something about insurance and you have to be at death's door before they eek some money out.
 

Nancy C. (795)
Saturday July 20, 2013, 9:07 am
My daughter was born in the 80's as well. The candle's burning at both ends now. Women have troubles keeping or losing a pregnancy. Life is tough enough w/o having to battle greedy political scandals to survive. If wisdom and/or humanity replaced greed we'd have a chance.
 

Dandelion G. (386)
Sunday December 1, 2013, 6:46 pm
Spammer reported. Yes, Marian 0 friends.....whose name is Katherine.
 
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