the US health care system seems to have achieved even higher levels of dysfunction. today’s new york times has a front-page article on the exorbitant cost and simultaneous deterioration of the maternity care system (see http://www.nytimes.com/2013/07/01/health/american-way-of-birth-costliest-in-the-world.html?nl=todaysheadlines&emc=edit_th_20130701&_r=0 ). the gist of the article is:
–several health insurance policies no longer cover maternity care, leaving it up to women/families to pay out-of-pocket
–hospitals are unable to give an even estimated cost for maternity/infant care (one women was initially told by the finance office of a hospital that they did not know the cost, then gave her a range of $4000-$45,000)
–the costs have been increasing dramatically, esp since hospitals have “unbundled” maternity care (used to be a package for a set amount of $. now each item is billed separately. a 20-minute ultrasound cost around $1150, after paying the radiologist $250, then the hospital component of $935 including the tech and “overhead”). costs overall have tripled since 1996. even removing the placenta has an additional charge. maternity care/newborn costs are now the largest single cost for most insurors. epidural anesthesia is in the $750-$1000 range (though costs $100 in germany)
–average total price for pregnancy/newborn care is now $30K for vaginal birth, $50K for c-section. although women used to pay nothing for maternity care, now the average out-of-pocket expense for those covered by insurance is $3400. it is still essentially free in all other developed countries. the average price spent overall for normal vaginal delivery in switzerland, france, and the netherlands maxes out at $4000 (though women in france stay in the hospital up to one week to make sure breast-feeding going well, etc — this was winowed down to 2 days in the US, since this is not “medically necessary”…..)
–at this point 62% of women covered by private (non-employer) plans do not have maternity coverage
–the US has among the highest rates of infant and maternal death among the industrialized nations
–part of the issue is the broken malpractice system (ob-gyn docs pay in the $100,000s range), but still the total going to the ob-gyns is <25% of the total maternity payment
–a large part is also that we do excessive testing (blood tests, scans, ER visits) and have a much higher C-section rate than other industrialized countries (and the individual costs of these are exorbitant). even though there are guidelines for use of ultrasounds, the article reports on mothers encouraged to get additional ones.
–one couple in new hampshire looked into adding maternity care to their insurance — an additional $10,000 per year ($800/month)!
–next year the Affordable Care Act will cover maternity care, though details are unclear. and, ironically enough, several of those states with the worst health outcomes are opting out of ACA (including almost the whole south and much of the pacific midwest).
–one of the issues is that maternity care is over-medicalized, with too many tests ordered, too much reliance on ob-gyns instead of midwives (who order fewer tests, have lower c-section rates, and for most women, provide better care)
and, health costs are still >50% of the reason people become bankrupt. this article really reinforces the absurdity of our piece-meal health payment systems, with wrong incentives, and over-medicalization for a procedure (childbirth) which is arguably an important social good (leads to new ones to replace us).
geoff