Childbirth Now Costs Nearly $3,000 for Insured Americans

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Better have some savings stored up before you rush to the delivery room: A new analysis shows the average out-of-pocket expense for delivering a child in the United States is nearly $3,000, even if you’re insured.

Other studies have looked at the costs for specific services, such as Cesarean sections versus vaginal deliveries, but those are only a small part of the picture. The road to recovery after giving birth can take a network of care, including a host of doctors and even therapists. So, the Kaiser Family Foundation analysis took a comprehensive view of the cost of pregnancy, including elements of post-delivery care.

As someone who’s been pregnant before, I know that’s not the only cost that comes up,” said Cynthia Cox, co-author of the analysis and a vice president at the Kaiser Family Foundation (KFF). “There’s postnatal care, postpartum care, but other things that may come about as well, like physical therapy.”

The analysis comes on the heels of the U.S. Supreme Court ruling that overturned the 1973 landmark Roe v. Wade decision guaranteeing women the right to an abortion. The new ruling could mean women who are denied abortions in states where the procedure is no longer legal could face hefty health care costs if they decide to have a child, even if they can’t afford it.

To determine just how much childbirth costs, the KFF researchers examined private insurance data from the IBM MarketScan Encounters Database from 2018 through 2020, and compared the average health spending for someone who gave birth versus someone who did not.

The investigators found that pregnant women incurred an average of nearly $19,000 more in health care costs than women who didn’t give birth. That included the cost paid for by insurance (averaged $16,011) and out-of-pocket expenses for the patient (averaged $2,854.)

But that’s just the cost of care for the mother. Once the child is born it might have its own deductible. If the baby needs to go into the neonatal intensive care unit or stay in the hospital for an extended period of time, that could be its own set of costs.

“The $3,000 is shocking but it’s just the first expense, possibly even one of the lower expenses someone can occur from giving birth in the United States,” Cox said. “Compared to other countries, they aren’t as likely to have this kind of out-of-pocket expense for the birth, but also longer parental leave and better access to childcare services.”

It’s not uncommon for soon-to-be parents to “shop around” for the best delivery units in their area, touring different facilities and meeting doctors, a practice that hospitals encourage. With nine to 10 months to plan, couples have plenty of time to figure out which hospitals are in-network and which doctors in those hospitals are in-network. That’s a level of planning simply not possible for most other medical situations, such as emergency room visits or unexpected surgeries.

Still, people can end up with surprise bills after giving birth.

“People and hospitals can prepare for this, and it’s still a very high-cost event,” Cox said. “Even though you may have shopped around, you may show up to the delivery room and there’s an anesthesiologist who’s out-of-network and you get overwhelmed with a surprise bill.”

Different kinds of deliveries can cost wildly different amounts, as well. From pregnancy to postpartum, people who give birth via C-section incur an average of $26,280 more in health care costs than women who don’t give birth. In contrast, this amount for women with a vaginal delivery averages just under $15,000.

Four in 10 U.S. births are covered by Medicaid, according to the KFF. But in some states where Medicaid has not been expanded under the Affordable Care Act (also known as Obamacare), coverage ends 60 days after delivery. After that mark, the new parents are on their own.

“Some of the costs and complications related to pregnancy can happen weeks or months after you deliver, like postpartum depression,” Peterson said. “We really need to reevaluate the way that public health insurance is provided here.”

Many insured cancer patients still experience serious money problems linked to their illness, new research affirms.

For example, nearly 3 out of 4 insured patients with colon cancer have major financial hardship in the year after their diagnosis, which affects their social functioning and quality of life, according to the study.

“The vast majority of cancer patients face financial struggles, in spite of having health care insurance,” said lead researcher Dr. Veena Shankaran, co-director of the Hutchinson Institute for Cancer Outcomes Research in Seattle.

The hardship is not limited to economically disadvantaged or uninsured patients, she added.

“As such, this is an important survivorship issue and needs to be addressed by providers, payers, clinics, health systems and policymakers,” Shankaran said, adding: “It is a widespread, highly prevalent issue that requires urgent solutions.”

While this new study focused on colon cancer, the financial toll of cancer care isn’t limited to that cancer alone, Shankaran said.

“There is no reason to think that colon cancer is more expensive to treat or affects ability to work any more than a variety of other advanced cancers,” she said. “I suspect that patients with breast, lung, lymphoma, prostate and other cancers face similar hardships.”

For the study, Shankaran’s team collected data on nearly 400 patients with colon cancer that had spread. Although 98% of them had health insurance, 71% had major financial problems stemming from their care, the study found.

The money woes included increased debt; the need to take out new loans or refinance or even sell their home; or a drop in income of 20% or more, Shankaran said. These problems take a toll on the patient’s quality of life, she noted.

And they affected all participants regardless of age, race, marital status, employment or annual income, the study found. The findings were published Jan. 4 in the Journal of the National Cancer Institute.

“Many have assumed that medical financial hardship only affects households without health insurance coverage or with very low income,” said Robin Yabroff, scientific vice president for health services research at the American Cancer Society. “These findings suggest that financial hardship is widespread and may affect millions of patients and their families, especially as the costs of cancer care continue to increase.”

Yabroff, co-author of an editorial that accompanied the study, said routine and comprehensive medical financial hardship screening of patients with cancer is a must. Such screenings can help point patients to support services, she added, urging policymakers to consider it a part of quality health care.

Other research has shown that patients with cancer increasingly face high out-of-pocket costs and may need to make trade-offs between paying for their cancer care and basic needs such as food, housing and utilities, Yabroff said.

Patients also delay or forgo recommended cancer care as well as other needed medical services, because they can no longer afford it.

“The adverse effects of financial hardship on health underscore the need to identify patients experiencing hardship and intervene to address it,” Yabroff said.

She said providers, cancer centers and state and federal health policymakers must develop ways to ensure that advancements in cancer care are widely accessible without inflicting financial ruin on patients and families.

Editorial co-author Cathy Bradley, professor and associate dean for research at the University of Colorado School of Public Health, added that policy solutions are urgently needed, including more comprehensive insurance coverage, caps on out-of-pocket expenses and slowing the growth in treatment costs.

“Financial hardship will persist until there is a unified effort to curb costs,” Bradley said. “Policymakers, providers and payers all have a role in reducing these costs. Without such efforts, the remarkable progress made in cancer treatment will be inaccessible for most patients.”


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