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Originally published Sunday, June 30, 2013 at 6:29 PM

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Delivering bundle of joy costs most in U.S., study finds

Even though maternity care costs far less in other developed countries than it does in the United States, studies show women there do not have less access to care during pregnancy than Americans do.

The New York Times

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LACONIA, N.H. — P regnant 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 4 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 their citizens do not have less access to care or to high-tech care during pregnancy than Americans do.

“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 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. 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 rose 49 percent for vaginal births and 41 percent for Caesarean sections in the U.S., with average out-of-pocket costs jumping 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 $18,329 and $27,866, the report found.

Women with insurance pay out of pocket an average $3,400, according to a survey by Childbirth Connection, one of the groups behind the report.

In most other developed countries, comprehensive maternity care is free or cheap, considered vital to ensuring the health of future generations.

Ireland, for example, guarantees free maternity care at public hospitals, though women can opt for private deliveries for a fee.

In the U.S., 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, a 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.

Each new test is a new source of revenue, from the hundreds of dollars billed for the simple blood typing required before each delivery to the $20 or so for the splash of gentian violet used as a disinfectant on the umbilical cord (Walgreens’ price per bottle: $2.59).

Obstetricians, who used to do routine tests like ultrasounds in their office as part of their flat fee, now charge for the service or farm out such testing to radiologists, whose rates are far higher.

One factor that has helped keep costs down in other developed countries is the extensive use of midwives, who perform the bulk of prenatal examinations and even simple deliveries; obstetricians are regarded as specialists who step in only when there is risk or need.

Sixty-eight percent of births are attended by a midwife in Britain and 45 percent in the Netherlands, compared with 8 percent in the United States. In Germany, midwives were paid less than $325 for an 11-hour delivery and about $30 for an office visit in 2011.

If the high costs of maternity care are not reined in, it could break the bank for many states, which bear the brunt of Medicaid payouts. The federal-state government health insurance program for the poor pays for more than 40 percent of all births nationally, including more than half of those in Louisiana and Texas.

But even Medicaid, whose payments are regarded as so low that many doctors refuse to take patients covered under the program, paid an average $9,131 for vaginal births and $13,590 for cesarean deliveries in 2011.

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