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January 9, 2020

The 'staggering' out-of-pocket cost of giving birth in America

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    The average out-of-pocket cost for giving birth in the United States increased from $3,069 in 2008 to $4,569 in 2015, largely due to the rise of high-deductible health plans, according to a study published Monday in Health Affairs.

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    Study details

    For the study, researchers looked at 657,061 American women with employer-sponsored health insurance who gave birth between 2008 and 2015. Using claims data, the researchers analyzed the cost of all treatments and services the women received in the year before they gave birth and for the three months following delivery. All costs were adjusted for inflation.

    The researchers found that, on average, the out-of-pocket costs for childbirth rose from $3,069 in 2008 to $4,569 in 2015.

    When it came to vaginal delivery, average out-of-pocket costs increased from $2,910 in 2008 to $4,314 in 2015. Out-of-pocket costs for cesarean birth increased from $3,364 in 2008 to $5,161 in 2015.

    According to the study authors, rising deductibles are behind the increases in out-of-pocket costs. The researchers found that the percentage of women with deductibles increased from around 69% in 2008 to about 87% in 2015.

    The researchers noted that a greater share of the cost-sharing for childbirth was landing on women's shoulders. Women who had vaginal births paid around 21% of their expenses in 2015, compared to 13% in 2008. Women who had cesarean births paid 15% of total costs on average in 2015 compared to 10% in 2008.


    Michelle Moniz, lead author of the study and an OB-GYN at the University of Michigan's Von Voigtlander Women's Hospital, said she's witnessed her patients dealing with rising out-of-pocket costs firsthand. "I sometimes see patients struggling to afford their health care and sometimes choosing not to obtain health care because they can't afford it," she said. 

    "These are no small co-pays," she added. "These are staggering amounts of money."

    Unplanned pregnancies can also make it "very difficult for people to prepare and save for this kind of expense," Moniz said. According to the Guttmacher Institute, almost half of all pregnancies in the United States are unplanned.

    David Anderson, a research associate at the Duke-Robert J. Margolis Center for Health Policy, who was not involved in the study, said the study does show how high deductibles can affect American patients, but said the study's dataset is somewhat limited.

    Including all medical care in the year preceding childbirth risks overestimating the total costs of childbirth-related medical expenses, Anderson said. For example, he noted that if a woman suffered a broken leg 11 months before she gave birth, that would have likely been included in the study.

    Moniz did acknowledge the limitation, but argued that limiting expenses to only those directly related to pregnancy would underestimate costs because some doctors' visits prior to birth would not be coded by insurers as related to pregnancy (Khazan, The Atlantic, 1/6; Schumaker, ABC News, 1/6).

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