New York state arguably holds the title of the most expensive place on Earth to give birth. Now, a study breaks down the overall cost of having a baby across the five boroughs of New York City.
The analysis, published May 6th by New York State Health Foundation, pinpointed the Bronx as having the highest median cost for a vaginal delivery under commercial insurance: a whopping $16,632 in 2017. This amount includes what is covered by both the patient and their health plan. That total is about 30% more than the price in Brooklyn, which recorded the lowest median cost. For cesarean sections, Queens is the most expensive borough, with a median cost of $21,842—50% higher than on Staten Island, the least costly.
But don’t go trekking to another part of the city just to give birth. The price also varies significantly within the same borough. In Manhattan, a cesarean section can range from $1,943 to $42,564—a more than 20-fold difference. Even patients receiving the same delivery services within a single hospital might get billed for wildly different amounts, depending on their insurance.
“We didn’t undertake this analysis to be a consumer-facing shopping tool,” said David Sandman, president and CEO of the New York State Health Foundation (which also funded WNYC/Gothamist’s year-long cost transparency project, PriceCheckNYC). “We were really interested in the policy angle, demonstrating a systemic issue of unwarranted price variation and the need for greater transparency in the health care system.”
While this study looked at the overall cost of childbirth, the amount Americans pay out-of-pocket for birth services has gone up as well, thanks to the pervasiveness of high-deductible health plans. A vaginal delivery under employer-based health insurance, on average, cost $4,314 in 2015—up from $2,910 in 2008. To make matters worse, patients can struggle to get an accurate estimate for a medical procedure ahead of time, and childbirth is no exception.
“For most people under 65, [having a baby] might be the most expensive health care event they have,” said Sandman.
The Trump administration established rules that aim to increase transparency in health care costs, although compliance among hospitals is minimal so far. Research shows that most people are also not interested in shopping around for the lowest-cost health care option, even when price information is available. Sandman says employers and the other private and public entities that manage health plans should be trying harder to influence hospitals to lower their prices for common events like childbirth.
“They're the ones who are paying the bills,” Sandman said, “and that gives them enormous power, which they have not necessarily maximized.”
The New York State Health Foundation study looked at various strategies for reducing childbirth expenses. It’s possible that if insurance entities pay less for care, those savings will be passed down to their members in the form of lower premiums or copays, although there’s no guarantee.
One idea came from the 32BJ Health Fund, a plan from a branch of the Service Employees International Union that covers 200,000 members in the metropolitan area. The union sought to address both high costs and high rates of complications in childbirth among its members, who include cleaners, food service employees and maintenance workers. In 2018, the Health Fund covered more than 1,000 births in New York and New Jersey, at a price tag of nearly $23 million, or $23,000 per birth.
The Health Fund sought to direct members to more cost-effective hospitals by creating a High-Value Maternity Network. It limited participation to medical centers that met quality criteria and were willing to share data on patient outcomes. The union then worked out payment arrangements with each hospital to incentivize cost-effective care. While encouraging members to buy into the High-Value Maternity Network, the Health Fund found it was more effective to focus on quality than cost. Many women were reluctant to leave trusted health care providers.
The New York State Health Foundation also examined the possibility of putting caps on the price of childbirth. Their study showed that in Brooklyn, 75% of vaginal deliveries cost less than $15,000. But some families paid up to twice as much.
So, in that instance, capping prices at $15,000 could potentially save a lot of money. Price fixing like this is uncommon in the U.S., although Maryland has created a comprehensive system for regulating hospital prices. Even there, evidence is lacking that the savings have trickled down to consumers.
For expectant families trying to navigate these expenses, some hospitals offer price estimators online for standard procedures. Keep in mind these tools can come with significant caveats. The Northwell Health estimator, for example, calculates hospital fees but leaves out physician fees, which are often charged separately. Your insurer might also be able to provide a clearer picture of the financials. The best bet for minimizing out-of-pocket costs is probably just to see if you qualify for Medicaid.
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May 12, 2021 at 09:24PM
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These NYC Boroughs Are The Most Expensive For Having A Baby - Gothamist
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