Pricy Pregnancy
Posted by on October 22, 2013 - 10:07am

We all know that having children is expensive, but did you know that having your child in the United States can cost up to triple or quadruple the price as other developed countries? Pregnancy care and delivery costs have nearly tripled in the United States since 1996 and now range anywhere from $4,000 to $45,000. Gerard Anderson, an economist at the Johns Hopkins School of Public Health who specializes in international health costs said, “It’s not primarily that we get a different bundle of services when we have a baby, it’s that we pay individually for each service and pay more for the services we receive.” Paying “more” is an understatement. In the United States, the cumulative cost of nearly four million annual births exceeds $50 billion dollars.

These astronomical prices hit families hard, especially when maternity is not covered by many private insurance plans. Data from 2011 conclude that 62% of women covered by private insurance plans in the United States lacked maternity coverage. Even when women do have maternity coverage on their plans, they are slammed by higher copayments and deductibles. From 2004 to 2010, the prices that insurers paid for childbirth rose 49% for vaginal births and 41% for Caesarean sections in the United States. It’s hard to imagine that merely 20 years ago insured mothers typically paid nothing more than a nominal fee if they opted for a private hospital room or a television.

While childbirth costs have skyrocketed in the United States, other developed countries continue to keep comprehensive maternity care cheap or even free. Why is there such a large discrepancy? The reason is that the United States bills item by item instead of charging a flat fee for the care of an expectant mother, like in other countries. Some hospitals are starting to catch on and offer all-inclusive rates for pregnancy, but this is difficult to standardize across the United States, as birthing costs differ by geographic location. Luckily, the Affordable Care Act will mandate maternity coverage so that no expectant mother should be left paying entirely on her own, but the law is not clear about what aids are included in this coverage. Expectant parents should be excited about expanding their families, not worried about their latest $900 bill for an ultrasound. However, being aware of these financial burdens will help families make wiser choices about their healthcare to protect their loved ones.

Source: The New York Times

Health Reform across the Border
Posted by on August 24, 2012 - 7:40am

The U.S. can learn from Mexico's recent efforts at health reform, especially as it relates to transferring care from specialists back to primary care physicians, researchers said.

Mexico created its national health insurance program, called the Seguro Popular in 2003, and achieved universal coverage for its 100 million citizens earlier this year, Felicia Knaul, PhD, of Harvard Medical School and colleagues wrote in the Aug. 16, 2012 edition of The Lancet.    The program now provides coverage to 52 million previously uninsured Mexicans, they noted.

Its list of essential covered services grew from 91 in 2004 to 284 in 2012 -- covering treatment for more than 95% of conditions in ambulatory units and hospitals, Knaul and colleagues wrote.  Meanwhile, Mexico also built 15 high-specialty centers, more than 200 hospitals, and almost 2,000 ambulatory clinics.

As the country slowly expanded coverage, its state-run specialty care centers became overcrowded with patients. To avoid facing a similar problem, the U.S. could learn to strengthen primary care's ability to provide follow-up treatment to patients recovering from catastrophic illnesses such as cancer, Knaul said in an interview with MedPage Today.

"That's not what primary care has been able to do well," she said.

The real challenge for the medical community will be how to train primary care doctors to handle that, Knaul said. It's not good for patients to continue to seek treatment at the specialty level, but it can be complex to link that follow-up care back to primary care doctors.

Regardless of how that's done, Mexican reform has shown it's possible to build financially responsible ways to treat chronic diseases alongside prevention, Knaul and colleagues wrote.

"Part of the global community has been convinced that middle-income and especially low-income countries should limit their activities to prevention in the case of chronic and noncommunicable diseases," the paper stated. That line of thinking is wrong and would conflict with the point of health reform, which is to provide affordable healthcare to all citizens, Knaul said.

For example, although treating a chronic illness like childhood asthma isn't expensive from month to month, Knaul pointed out that it adds up over time and can be financially burdensome.

Knaul knows of Mexican families living in the U.S. that have developed serious medical conditions, lost their jobs and their work visas as a result, and have returned to Mexico because they can be treated there. "Hopefully, this will change as a result of reform in the United States," she said.

Health reform in Mexico has spurred economic growth while improving health, Knaul noted. The infant mortality rate dropped from from 18.2 to 14.1 per 1,000 live births from 2000 to 2010. The percentage of deaths from communicable diseases also fell -- from 15.4% to 10.8% -- during the same period.

Meanwhile, the gross domestic product per capita in Mexico increased from $11,852.70 in 2000 to $12,440.90 in 2010.