The American Way of Birth, Costliest in the World

Giving birth to a baby in the United States is more expensive than anywhere else in the world. If you don't have health insurance, you'll be on the hook for the billed amount, which is much higher than insurance companies' negotiated prices. If you have health insurance, there's good chance it doesn't cover maternity costs. And even if it does, many services expectant mothers receive are often deemed unnecessary expenses by the insurance company -and therefore not covered. On the up side, a woman who finds out she is pregnant has time to shop around for the best deals… that is, if she knows that certain services are optional, and even then getting an estimate can be difficult. Renée Martin has insurance through her work, but it does not cover maternity expenses.

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.

Even with insurance, out-of-pocket expenses for childbirth have quadrupled in the past ten years. One of the reasons is that instead of a flat fee, maternity services are individually billed, often by many providers. Chris Sullivan and his wife bought a package deal for maternity care from the hospital for $4,000.

The couple knew that price did not cover extras like amniocentesis, a test for genetic defects, or an epidural during labor. So when the obstetrician suggested an additional fetal heart scan to check for abnormalities, they were careful to ask about price and got an estimate of $265. Performed by a specialist from the Children’s Hospital of Philadelphia, it took 30 minutes and showed no problems — but generated a bill of $2,775.

“All of a sudden I have a bill that’s as much as I make in a month, and is more than 10 times what I’d been quoted,” Mr. Sullivan said. “I don’t know how I could have been a better consumer, I asked for a quote. Then I get this six-part bill.” After months of disputing the large discrepancy between the estimate and the bill, the hospital honored the estimate.  

The New York Times has an extensive article about the soaring cost of maternity care, the lack of insurance coverage for much of it, and how the U.S. compares to other developed nations in the way it charges new parents for delivering a baby. Link  -via Digg

See more about baby and kids at NeatoBambino

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By the way, from a 2011 CIHI report, it looks like Nova Scotia is 6th in per capita health expenditures of provinces (7th if counting public funding only), but is still 6% above the national per capita spending, because the lowest per capita spenders are the most populated provinces: Ontario, Quebec and B.C. Ontario is 4th in per capita GDP (2nd in average income), so a lot of it still seems to depend on politics as much as income. Even so, the variation in per capita health care spending only varies from the national average by -10% to +15% for different provinces, while as a percentage of provincial GDP, it ranges from 8.6% to 15.6%.

Also, while I can't speak in general, at least for me, the last three US health insurance plans I had involved a co-pay and/or percentage of some procedures that had to be covered by the patient. It was small enough I didn't really noticed for a one-off thing or two, but when something came up that involve more tests and trips, or repeating visits, it started to add up, and factored slightly into decision making. Although I have no idea where the ideal would be in terms of making sure needed things are done without costing too much, but inhibiting excessive procedures.
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That’s a really good question that I hadn’t considered.

One reason is that citizens of a wealthy country will choose to spend more on health care. Of the countries in the Amount Paid for Childbirth graph, only the Netherlands and Switzerland have a GDP per capita similar to that of the U.S. Per data from 2010, the Dutch pay 9% more than we do per person every year for health care. Swiss citizens buy their own insurance rather than having the government or employers do so. I think that’s an important factor in keeping costs low. Here in the U.S., if we have insurance, most of don’t know or care how much our health costs are because someone else is covering the bill. If it was our money, as consumers we would make insurers and providers be more competitive and account for every penny. In Switzerland all packages require you to pay a portion of the costs to prevent wasteful procedures and the Swiss have the option of about 100 different insurance companies that offer different prices and services. Here we are limited to whatever insurance providers are licensed in our state or region.

We pay our doctors about twice as much more per person than Australia, Canada, France, Germany, or the UK. Cutting doctor reimbursement in the U.S. by over 20% is one of the ways in which the Affordable Healthcare Act plans to save money. The downside of that is medicine would become a much less attractive profession and we could run into doctor shortages. The UK solved that problem by bringing in foreign doctors. Their problem now, doctors who speak English so poorly they are a danger to their patients.

Something I would like to point out is that the report chose one health plan, either public or private, for the data in the graphs for every country except the U.S. For us they used they calculated averages from nearly a hundred different health plans. Some of the foreign plans aren’t even representative of the entire country. The information for Canada is from, “public sector prices for the province of Nova Scotia.” Each province or territory in Canada has a different health care system. Nova Scotia is a great province, but the with the second lowest GDP per capita of any province or territory in Canada I’d assume its health care costs are much lower than the rest of the country. That would be roughly equivalent to using the figures for Idaho to represent the entire U.S. Given the limited information for other countries and the seemingly cherry-picked regions, the numbers are highly suspect.

We could learn from other countries, but we need to do so with our eyes open. Unfortunately, there aren’t many unbiased sources of information out there on this topic.
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