Medicine
Elisabeth Rosenthal's New York Times story on the staggering costs of maternity care in the U.S. featured a short interview with my wife, a family physician who last year gave birth to our third child with a nurse-midwife 12 minutes after arriving at the hospital. She had no postpartum complications and stayed only one night, but nonetheless received a bill of more than $6000 (we received a separate bill for newborn care). Here's what she had to say about the disconnect between this price and her delivery experience:
“Most insurance companies wouldn’t blink at my bill, but it was absurd — it was the least medical delivery in history,” said Dr. Duane, who is taking a break from practice to stay home with her children. “There were no meds. I had no anesthesia. He was never in the nursery. I even brought my own heating pad. I tried to get an explanation, but there were items like ‘maternity supplies.’ What was that? A diaper?”
Pregnancy care costs illustrate 4 reasons that Americans spend far more on health care than residents of any other country in the world: prices for services are too high; you can't find out the prices before you buy the services; the payment model incentivizes providing services that are unnecessary, nonbeneficial, or potentially harmful (e.g., extra fetal ultrasound scans, electronic fetal monitoring during labor); patients with "good insurance" (like the type that paid for the births of our two older children) are insulated from the true cost of their care. (The hospital bill for our second child's birth was more than $8500, but since we only paid $100 out-of-pocket, it was hard to get too worked up about that.)
The solutions to these problems are not simple. Unfortunately, health reform only requires that insurers provide some maternity coverage but doesn't contain skyrocketing prices or discourage doctors from doing things to pregnant women that aren't medically necessary. But how do you know what's medically necessary? Is attempting a vaginal birth after a C-section safe? How about a planned home birth? Here are answers to these and other women's health issues I've blogged about in the past:
1) The decline of VBAC: hearing hoofbeats, thinking zebras
A trial of vaginal birth after Cesarean (VBAC) is successful more than 75 percent of the time. It's a real shame that women in the U.S. are discouraged from attempting them more often.
2) VBAC and home birth: evaluating the evidence
The available evidence indicates that planned home birth is no riskier for babies, compared to planned hospital birth, than is attempting VBAC compared to choosing a repeat Cesarean delivery.
Classifying contraceptives as preventive services and treating pregnant women as if they have fatal diseases is not a rational way to go about improving women's and maternal health outcomes.
4) The next all-natural blockbuster drug
Breastfeeding 90% of U.S. children for the first 6 months of life could potentially save the lives of more than 900 infants and $13 billion per year.
Most women overestimate both their personal risk of developing breast cancer and the potential benefits of screening, driven in part by well-intentioned advocacy campaigns to raise "cancer awareness."
- Improving One's Chances For A Successful Vaginal Delivery
Two of the most important questions that pregnant women have are: 1) How can I improve my chances of having a normal (vaginal) delivery? and 2) Does where I plan to have my baby make a difference in birth outcomes? In the August 1st issue of American...
- Once A Cesarean ... Now, A Vaginal Delivery
A recent essay in the "Narrative Matters" section of Health Affairs by physician and health policy researcher Carla Keirns highlighted the challenges that even a highly educated, well-informed patient faces in achieving the desired outcome of a vaginal...
- Vbac Redux
Several months ago, I wrote in this blog about the precipitous decline of vaginal births after Cesarean (VBAC) in the U.S., which I attributed in part to the the internalization by obstetric specialists of the medical maxim "hearing hoofbeats, thinking...
- The Decline Of Vbac: Hearing Hoofbeats, Thinking Zebras
My daughter, who turns two years old in June, is becoming something of a medical rarity. This isn't because she is showing signs of a late-developing handicap or extraordinary ability for her age - it's because she came into the world as a vaginal...
- Does The Type Of Birth Affect Postpartum Health?
My first child was born surgically via cesarean section, while my second arrived naturally by what maternity care providers call a “normal spontaneous vaginal delivery.” Surgical deliveries are rapidly becoming the norm rather than the exception in...
Medicine
What pregnancy care costs, and related writings
Elisabeth Rosenthal's New York Times story on the staggering costs of maternity care in the U.S. featured a short interview with my wife, a family physician who last year gave birth to our third child with a nurse-midwife 12 minutes after arriving at the hospital. She had no postpartum complications and stayed only one night, but nonetheless received a bill of more than $6000 (we received a separate bill for newborn care). Here's what she had to say about the disconnect between this price and her delivery experience:
“Most insurance companies wouldn’t blink at my bill, but it was absurd — it was the least medical delivery in history,” said Dr. Duane, who is taking a break from practice to stay home with her children. “There were no meds. I had no anesthesia. He was never in the nursery. I even brought my own heating pad. I tried to get an explanation, but there were items like ‘maternity supplies.’ What was that? A diaper?”
Pregnancy care costs illustrate 4 reasons that Americans spend far more on health care than residents of any other country in the world: prices for services are too high; you can't find out the prices before you buy the services; the payment model incentivizes providing services that are unnecessary, nonbeneficial, or potentially harmful (e.g., extra fetal ultrasound scans, electronic fetal monitoring during labor); patients with "good insurance" (like the type that paid for the births of our two older children) are insulated from the true cost of their care. (The hospital bill for our second child's birth was more than $8500, but since we only paid $100 out-of-pocket, it was hard to get too worked up about that.)
The solutions to these problems are not simple. Unfortunately, health reform only requires that insurers provide some maternity coverage but doesn't contain skyrocketing prices or discourage doctors from doing things to pregnant women that aren't medically necessary. But how do you know what's medically necessary? Is attempting a vaginal birth after a C-section safe? How about a planned home birth? Here are answers to these and other women's health issues I've blogged about in the past:
1) The decline of VBAC: hearing hoofbeats, thinking zebras
A trial of vaginal birth after Cesarean (VBAC) is successful more than 75 percent of the time. It's a real shame that women in the U.S. are discouraged from attempting them more often.
2) VBAC and home birth: evaluating the evidence
The available evidence indicates that planned home birth is no riskier for babies, compared to planned hospital birth, than is attempting VBAC compared to choosing a repeat Cesarean delivery.
3) Unintended consequences of "pregnancy prevention"
Classifying contraceptives as preventive services and treating pregnant women as if they have fatal diseases is not a rational way to go about improving women's and maternal health outcomes.
4) The next all-natural blockbuster drug
Breastfeeding 90% of U.S. children for the first 6 months of life could potentially save the lives of more than 900 infants and $13 billion per year.
5) Breast cancer and the Angelina Jolie effect
Most women overestimate both their personal risk of developing breast cancer and the potential benefits of screening, driven in part by well-intentioned advocacy campaigns to raise "cancer awareness."
- Improving One's Chances For A Successful Vaginal Delivery
Two of the most important questions that pregnant women have are: 1) How can I improve my chances of having a normal (vaginal) delivery? and 2) Does where I plan to have my baby make a difference in birth outcomes? In the August 1st issue of American...
- Once A Cesarean ... Now, A Vaginal Delivery
A recent essay in the "Narrative Matters" section of Health Affairs by physician and health policy researcher Carla Keirns highlighted the challenges that even a highly educated, well-informed patient faces in achieving the desired outcome of a vaginal...
- Vbac Redux
Several months ago, I wrote in this blog about the precipitous decline of vaginal births after Cesarean (VBAC) in the U.S., which I attributed in part to the the internalization by obstetric specialists of the medical maxim "hearing hoofbeats, thinking...
- The Decline Of Vbac: Hearing Hoofbeats, Thinking Zebras
My daughter, who turns two years old in June, is becoming something of a medical rarity. This isn't because she is showing signs of a late-developing handicap or extraordinary ability for her age - it's because she came into the world as a vaginal...
- Does The Type Of Birth Affect Postpartum Health?
My first child was born surgically via cesarean section, while my second arrived naturally by what maternity care providers call a “normal spontaneous vaginal delivery.” Surgical deliveries are rapidly becoming the norm rather than the exception in...