The American Pregnancy Care Paradox: Paying More and More for the Same Poor Outcomes


America is an expensive place to give birth – the “most expensive in the world”, according to The New York Times. Childbirth in most other countries is free or cheap for almost all citizens.

But when it comes to prenatal and pregnancy care, as with medical care in general, the expensive American system does not deliver first-rate results. On the contrary: The Mapping Health site has observed that when it comes to maternity care, costs have increased without any corresponding increase in results. The average cost of giving birth doubled between 1993 and 2009, yet the maternal death rate has increased. In other developed countries, this rate declined during this period. Likewise, the infant mortality rate and the incidence of low birth weight (an indicator of unhealthy babies) in the United States have unfortunately remained stable. Since 2009, the country has made no progress in matching the lower infant mortality rates of its peer countries. In terms of maternal mortality, the CIA World Factbook puts the United States on a par with Iran.

Poverty certainly plays a role in this – the gap between infant mortality rates among rich and poor Americans mirrors those in developing countries – but poorer citizens are not on their own. responsible for the low US averages. “Even highly advantaged Americans are in poorer health than their counterparts in other ‘peer’ countries,” concludes a 2013 report from the National Academies Press.

American parents are therefore paying more and more for prenatal services and getting less and less for their money. Because they have not banded together to demand a change to this status quo, it stands to reason that they are paying for a service they deem satisfactory. This I do not know what is most likely heartwarming personalized attention, or what researchers call “high quality” prenatal care.

According to Gerard Anderson, director of the Johns Hopkins Center for Hospital Finance and Management, the maternal care system is designed for a well-insured, well-paid woman. It is assumed that, given that the typical patient will only have one or two pregnancies in her lifetime, she will want state of the art, high quality care and will not hesitate to pay out of pocket for her share. Indeed, it can even be expected. “We don’t have a lot of babies,” he told me, “so we want it to be a really enjoyable experience. “

Rebekah Tilley, a freelance writer who lives in Iowa, had four children. All of her births were at low risk and none had serious complications. Their prices ranged from free (one in Denmark, with socialized medicine, and one in Minnesota, with Medicaid) to well over $ 1,000 (one in Kentucky, with conventional insurance). Tilley’s favorite experience was in Iowa with her fourth child. Her family insurance plan cost $ 250 a month and covered everything, including her hospital stay. “I didn’t even have a co-pay,” she says. The fact that she knew that her insurance would cover the costs led her to agree to certain treatments, encouraged by her obstetrician, which were, she admits, “largely unnecessary”.

And, while her all-expense-paid experience in Copenhagen has been excellent, Tilley notes that the Danish system is much more rudimentary and hands-off than she was used to. She puts it in terms of groceries: “It was like prenatal care in an Aldi, where you pack your own groceries and return your own cart, rather than a HyVee, where you can get breakdown assistance or order your groceries. online shopping. “The Danish practitioners offered fewer tests and procedures and expected her to take her own papers with her. This is part of the reason she preferred the American method, as long as she was comfortably and comfortably assured. affordable price.

Holly Noonan, who currently works at a dog day care center in Charleston, South Carolina, had two Caesarean sections while teaching English in Turkey. “Private hospitals in Turkey are generally very clean and inexpensive by US standards,” she says. In addition, “the price is great. I paid the equivalent of about $ 2,500 for my first son’s caesarean in 2007 and it wasn’t much more for my second caesarean in 2009. ”But she was annoyed at the wait for patients. take much of the responsibility for their own care. “Not even two hours after my operation, I asked a nurse to give me a blanket so that I could breastfeed my baby and she told me that it was not her job and that I had to do it”, she says. “Then she scolded me for not having someone with me to help me.”

Noonan, Tilley and other Americans accustomed to the high contact pattern might feel even more alienated from Chinese antenatal care, which, while good for keeping babies and mothers healthy, has been described as impersonal, if not ” factory type ”. Indeed, the Chinese model may seem spartan to Westerners, but it is profitable. Most “routine” care is free and the required co-payments are quite modest. Even Caesarean sections, which are extremely popular on the mainland, cost less than $ 1,000. In contrast, the average cost of a Caesarean section in America, including what the patient and insurance pay, is over $ 50,000, or 50 times more.

Women confined to the United States for their pre- and postnatal experiences can still experience a significant difference in the cost of care, as Noonan discovered when she found herself pregnant once in Iowa and once in the United States. Kentucky. According to a 2013 report, even with commercial insurance, a patient’s share of expenses can vary widely: among the five states studied, researchers found that for a female consumer, a vaginal birth was the most affordable in Louisiana ( $ 10,318), and a C -section was the least affordable in California ($ 21,307).

Even with this discrepancy, no US state has fully understood how to keep costs down to levels considered normal anywhere else in the world. That won’t change as long as parents want memorable prenatal and childbirth experiences and continue to insist that hospitals are full of expensive machines and highly paid specialists in case something rare happens. “In many cases, [patients] have a really good personal experience, ”Anderson says,“ until they see the bill. “

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