How much does childbirth cost?

Just a quick link here:  NPR published an article, “I’m Pregnant. What Would Happen If I Couldn’t Afford Health Care?” that claimed that

All told, my prenatal care with all visits and tests included would be over $10,000. This is not counting labor and delivery, which in my area is estimated to be up to $30,000 for a vaginal birth and $50,000 for a cesarean section.

Is this legit?  My understanding had always been that childbirth costs ran about $10,000 or thereabouts.  Many years ago, when I was pregnant with my now-9 year old, I used to follow the discussion boards on sites such as babycenter.com, and remember threads on costs of childbirth not being unusual, particularly for women who had individual insurance that didn’t cover maternity, so they needed to manage the costs themselves through careful budgeting, planning, and arranging.  There’s no way this would be possible with a $30,000 / $50,000 rate.

So I googled a bit and found a summary of childbirth costs at cnbc.com; the average is indeed less than that, at $8,775 for a vaginal birth and $11,525 for a c-section.  This takes into account the amount that the employer/insurer pays and the amount that an individual pays out-of-pocket, so the numbers wouldn’t be directly applicable to an uninsured patient (though perhaps an individual insurance policy without maternity coverage still included the negotiated discounts, and it’s my understanding that it is possible to negotiate bills down if you are fully-uninsured).  These numbers are still high, but they put it in the range of possibility that one could imagine paying for this, in the same way as you’d pay for other large expenses.  After all, it’s still less than a year’s worth of daycare.

But here’s the other thing that this CNBC report revealed:  the differentials across the country are astounding.  For a vaginal birth, of the nation’s 30 largest metro areas, Kansas City came in the lowest at about $6,000; Sacramento and San Francisco both were $15,000.  And even within a given metro area, prices varied considerably by provider:

[Study producer] Castlight Health’s home city of San Francisco had the highest observed price for a routine vaginal delivery, a whopping $28,541.

Another city in California, San Diego, had the lowest observed price for a routine delivery — just $3,243.

and

The disparities were even bigger when Castlight looked at the costs of c-sections.

Los Angeles had the top price observed for c-sections: $42,530.

The lowest price for a c-section was seen in Pittsburgh, Pennsylvania, where it cost $4,419 — nearly 10 times less than L.A.

For average prices for c-sections, Sacramento again had the most expensive average price, at $27,067. San Francisco again held second place, with an average of $21,799.

Orlando, Florida, had an average c-section price of $12,232, putting it in the middle of the pack for the cities examined.

The lowest average price was in Pittsburgh, at $6,891 — which was four times less than Sacramento’s average.

These price variations are only partly due to differences in cost of living in these areas.  Even within a metro area, there’s a lot of variation:

Castlight’s report said that the “shockingly higher” average prices in cities such as Sacramento and San Francisco are related to the consolidation of health providers in those places, resulting in less competition for patients.
But San Francisco also was one of the cities which has a very wide range of prices for deliveries.

Castlight said the lowest cost seen for a c-section delivery in San Francisco was $8,399, which was five times less than the highest cost seen in the city, $41,191.

In Los Angeles, the lowest cost for a c-section, at $6,232, was nearly seven times less than the highest cost c-section, at $42,530.

So I don’t know in what world the NPR author can say that childbirth costs $30,000, especially since, at least in a metro area and other than emergencies, there are options to plan (though I also recall reading moms-to-be struggling to get hospitals to give out costs in advance).  Perhaps the $30,000/$50,000 is a cost that assumes an uninsured patient with every possible potential expense at the most expensive hospital?

But it is a useful reminder that this huge variation in cost across regions points to a need to figure out how to get costs down, rather than just figure out who’s going to pay for them.  (It seems to me that I read a book about this, but I’m not sure when — in any case, Overtreated is a similar book on healthcare costs.  I wrote about this quite some time ago, though, I’ll warn you, it looks like my planned “part 2” never happened.)

Image:  from flickr, https://www.flickr.com/photos/davidswiftphotography/2200020857; Creative Commons 2.0