Everything Under The Sun: What Is Reasonable Pre-Natal And Birth Care?

Johns Hopkins Bloomberg School of Public Health, 100 years old next year.

I bet that if most of you were asked, you would probably say that the amount of care provided to pregnant women in this country would lead to a relatively low infant mortality rate. But you would be wrong. Despite increasingly higher costs for pregnancy and maternity health care, the rate of infant deaths remains relatively high, so high, in fact, that it matches the rate in Iran. There has been no statistical progress in reducing infant mortality rates since 2009.

Why? Gerard Anderson, who is the director of the CENTER FOR HOSPITAL FINANCE AND MANAGEMENT AT JOHNS HOPKINS, part of Johns Hopkins Bloomberg School of Public Health, based in the Baltimore area, where I live, believes that today's health care system is designed for women who are well-insured and part of a high-earning family. In this world of wealth, most patients are assumed to want only two children at most, want the very best amenities and cutting-edge care, and are willing to fill in the gaps if insurance doesn't cover it. So the assumption, according to Mr. Anderson, is "We're not having very many babies, so we want it to be a really pleasant experience."

So, what happens elsewhere? Say, in Denmark, the government picks up the costs, but the care is much less personalized, with patients doing such things as receiving fewer tests and procedures and carrying their paperwork from department to department. In China, pre-natal care is routinized, not customized, so it is more cost effective, but it maintains healthy care. If a woman needs a c-section, that costs around $1,000. Most patients bring their own helpers for hospital care. In the US, though, C-sections cost a whopping $50,000; both insurance and patients share the costs in some manner.

Costs can vary here in the US, dependent on where a person lives. Even when a woman has insurance, a patient's share of the costs varies by plan, depending on the deductible amount and percentages that patients are asked to co-pay. That doesn't even count the little amenities that are offered, but not covered by insurance. In a study of five different States, it was found that Louisiana provided the lowest cost vaginal birth at $10,318 and the highest cost of C-sections came from California at $21,307 in 2013.

Not a single State has managed to figure out how to limit costs to the same extent as what is charged in the rest of the developed world. As long as expectant parents expect all of the luxuries, tests, and fancy equipment that they do today for their best feel-good experience, none of that will change. As Mr. Anderson maintains, "In many cases, [patients] do have a very good personal experience, until they see the bill."

Twitter chat with Dr. Josh Sharfstein, Dr. Shelley Hearne, and Dr. Leana Wen.

So, as a people, we must consider how important all of these extras are to the care we receive. It's obviously not affecting the quality of the health of a newborn, as evidenced by the higher mortality rates. Shouldn't we be focusing more upon how to make sure that infants survive and flourish in the best way possible, in a way that we can all afford? Surely, it isn't that difficult to carry your own papers to another department, or for a family member to refill your water pitcher. Let's be sensible, find out what evidence shows is the proper care, and fund that for everyone.