Cost Of Birth In State Varies Widely
The cost of delivering a child in California's hospitals varies widely, according to a new study conducted by researchers at UC San Francisco.
UCSF researchers studied the records of nearly 110,000 births that occurred in California in 2011 – about 20% of the statewide total that year, analyzing data provided by the Office of Statewide Health Planning and Development. They examined nearly 77,000 vaginal births and nearly 33,000 Caesarean sections.
Their conclusion: Hospital charges ranged from $3,296 to $37,227 for a vaginal delivery, while charges for a C-section ranged from $8,312 to $70,908.
"Childbirth is the most common reason for hospitalization, and even for an uncomplicated childbirth, we see a staggering difference in what hospitals charge, even for the same, average patient," said Renee Y. Hsia, M.D., a UCSF associate professor of emergency medicine and the study's lead author.
Government hospitals were the least expensive, charging 14.6% less on average than non-profit facilities. For-profit hospitals charged 17.2% more than non-profits. Hospitals located in counties with large numbers of uninsured patients tended to charge less than facilities located elsewhere.
Hsia said the huge variation was reflective of the “appalling state of affairs of healthcare in the United States,” Hsia noted, and was particularly unfair to patients given the recent trends in cost shifting by insurers.
"These charges affect not only the uninsured, but also the fee-for-service reimbursements by some private insurers, which can translate to out-of-pocket costs for patients," Hsia said.
On average, the discounted price insurers paid amounted to 37% of the hospital's original bill. Discounted prices for vaginal deliveries ranged from $835 to $12,873, while the prices of discounted C-section deliveries ranged from $1,135 to $28,105. One unnamed facility discounted charges by more than $29,000.
Altogether, the hospitals billed $1.3 billion more than they received from insurers.
Hsia and the study's other authors said the current healthcare finance structure is outdated, particularly given the trend of cost-shifting to patients. And uninsured patients were most likely to be charged the full price, necessitating charity care or drawn-out payments by the patient and their families was likely.
“At a time when out-of-pocket payments for health care are increasing, and the growing number of ‘consumer-directed,’ high-deductible health plans put more pressure on patients to make cost-efficient health care decisions, the opacity of health care pricing is increasingly concerning,” the study concluded.
The study was funded by the UCSF-Clinical and Translational Science Institute, the Robert Wood Johnson Foundation Physician Faculty Scholars Program, as well as a grant from the UCSF Center for Healthcare Value.
The study was published in the most recent edition of an online version of the British Medical Journal.
