By Jenny Gold, Kaiser Health News

Recently, Johnny Harris, a soon to be parent, tried to find out how much his child's upcoming birth was going to cost the family and was basically led on a wild goose chase. He spent hours talking to billing departments, insurance companies and hospital administration, without actually getting the answers he was seeking. He wrote about this experience and also produced a video, both which you can find here. Yesterday, Jenny Gold, a writer for Kaiser Health News, a national health policy news service that is part of the nonpartisan Henry J. Kaiser Family Foundation wrote about the huge variation in the costs of birth in different geographic locations in the USA. Not surprisingly, the same procedure had widely different costs depending on where the birth was occuring. It should be noted that the costs of the births are not correlated with the quality of the facility in terms of the standard benchmarks used for evaluating hospitals and obstetrical care. This wouild be an interesting project to take on.

As educators and birth professionals, we encourage families to choose a birth location and a provider whose values line up with their own preferences. For some families, there are few if any options available if they wanted to make a change from their current situation. Additionally, cost may be a factor for those who share expenses with their insurance plan or are self-pay. Where does your city line up in the top 30? Do the families in your classes know what the cost of delivering at their chosen birth place is? How can they be good health consumers if they are missing that critical piece of information in their desire to receive evidence based care? - Sharon Muza, Community Manager, Science & Sensibility

Everyone knows that real estate is no bargain in Northern California. It turns out that giving birth ain't cheap either.

New research on the cost of childbirth in the nation's 30 largest metropolitan areas ranks Sacramento and San Francisco as the two most expensive for both vaginal delivery and Cesarean sections.

The study, based on private health insurance claims from this year and other data, shows the totals actually paid for childbirth by employees and employers. It was conducted by Castlight Health, a San Francisco-based health care information company that analyzes medical costs to help consumers and purchasers compare prices.

A vaginal delivery costs an average of $15,420 in the Sacramento area and $15,204 in San Francisco - nearly $4,000 more than the third-most expensive location, Minneapolis. In the least expensive metropolitan area, Kansas City, a vaginal delivery costs $6,075.

C-sections are even more expensive, costing an average of $27,067 in Sacramento - nearly four times as much as in Pittsburgh, the cheapest city. San Francisco had the second highest cost for C-sections, at $21,799. San Diego came in fifth at $16,810.

The data show that prices vary widely even within the most expensive regions. In San Francisco, for example, the cost for a Cesarean delivery ranged from $8,399 to $41,191 - a five-fold price difference. Patients, however, rarely know how much a procedure will cost until they receive the bill.

(Courtesy of Castlight Health)

 

It's a black box when it comes to pricing in health care," said Kristin Torres Mowat, a Castlight senior vice president. "There is not a rational explanation for this kind of variation for similar procedures in the same geography. It highlights how inefficient the health care market is."

Mowat said the high costs in Northern California might have to do with the consolidation of providers in the market. Most obstetricians, for example, work for relatively few major medical systems, including Sutter Health and Dignity Health, which have been singled out recently for high prices. "The less choice and competition there is, the higher the pricing," she said.

The data in the study did not reflect the quality of care relative to the cost, making it difficult to assess value. "As consumers, we assume that the highest cost is going to be the best quality, but that is not true in health care," said Mowat.

Comparison shopping is key to making sure consumers get a good deal, but it can be challenging. Even when patients try to call around to their local hospitals to compare prices, the hospitals are rarely forthcoming, said Katy Kozhimannil, an associate professor at the University of Minnesota's School of Public Health.

Getting information about health care costs is "next to impossible," said Kozhimannil. And that makes it easier for players in the industry to make money, she said.

Kozhimannil noted that families and individuals are paying for a growing share of their medical care. "Increasingly, with high-deductible plans, women and families are on the hook for a greater part of the cost of childbirth," she said.

This material is republished with permission of Kaiser Health News and the author.

About Jenny Gold

Jenny Gold covers the health care industry, overhaul and disparities for radio and print. Her stories for KHN have aired on NPR and been printed in USA Today, the Washington Post, McClatchy and MSNBC. She was previously a Kroc Fellow at NPR, where she covered health and business, and a broadcast associate at the CBS Evening News. She is a graduate of Brown University. Jenny can be reached at jgold@kff.org and on Twitter @JennyAGold.

 

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