Katy B. Kozhimannil, PHD, MPA, is an associate professor in the Division of Health Policy and Management at the University of Minnesota School of Public Health and Director of Research at the University of Minnesota Rural Health Research Center. Her research applies health policy and health services research to the field of women's health, with a focus on maternal and child health. Dr Kozhimannil conducts research to inform the development, implementation, and evaluation of health policy that impacts reproductive-age women and their families. Twitter @katybkoz. E-mail email@example.com
Pregnant women need clear, transparent information on the costs associated with childbirth so they can derive the most value form the healthcare they receive.
Earlier this month, Ester Bloom wrote in the Atlantic Monthly about the health insurance coverage she has through Obamacare. It’s complicated. She’s grateful to have coverage, but she’s facing a big out-of-pocket deductible, and she is pregnant, making choices about prenatal care, and anticipating future childbirth expenses. These decisions, which are never straightforward, are made more complex for her because of limited access to information on the costs of tests, ultrasounds, and other prenatal services. This is not a new problem—the unique challenges that pregnant women face in finding out about the costs of care are well-known and can cause great personal suffering. But it’s an increasingly urgent problem.
According to data from the Kaiser/HRET Employer Health Benefits Survey, 1/5 of all American workers had high-deductible plans in 2014. And the “Bronze” category of plans available via state-based health insurance exchanges—the type of plan that Ester Bloom and her husband have—are the most common insurance product purchased on the exchanges.
Increasingly, accessing information on the actual costs of services is a top priority for many Americans. But it takes on particular salience for a pregnant woman who is anticipating the costs of prenatal care, labor and delivery, a hospital stay, postpartum follow-up, and then...the medical costs for a baby.
Fortunately, efforts are underway to improve access to information about the costs of healthcare services. For example, California Insurance Commissioner Dave Jones announced last week the launch of California Healthcare Compare, a collaboration with the University of California San Francisco and Consumer Reports. This is a new tool, designed to provide individuals and families with information about prices and quality for healthcare services. The information is supposed to be clear, relevant, straightforward, and easy-to-use.
Attempts to address the knowledge gap about costs of care are especially important during pregnancy, when care is anticipated well in advance. Pregnancy care offers many opportunities to make informed decisions about value—but only if women have knowledge about costs and benefits of care. For a pregnant woman to seek out high-value care, there are 2 information components required:
Information on the clinical benefits should ideally come from a clinical care team, and be thoroughly discussed in a patient-centered, respectful manner. However, determining value also requires cost information, which has thus far been woefully inadequate, generally, and for childbirth care, specifically.
Certainly, there will be lesson’s to learn from California’s experience. It’s likely that there will be real-world challenges that women face in using this (and other) cost and quality information, and applying it to their own individual circumstances. For example, most women can’t anticipate in advance whether they will need a cesarean, or whether their course of labor will necessitate pain medication or antibiotics or other medicines or procedures. As such, saving and planning in advance—even when prices are fully transparent—is very difficult. But initial steps toward greater access to cost information are welcomed, and indeed necessary. For women whose pregnancies are advancing, day by day, week by week, toward their due dates, this information can’t come fast enough.
In her article about being pregnant and having insurance through Obamacare, Ester Bloom movingly describes her family’s release from job lock (having sacrificed professional dreams to stay in jobs that provided health insurance) and appreciation for the insurance options available to her, but—just as genuinely, and perhaps more urgently—she really needs to know how much an ultrasound will cost. Ester Bloom, and all other pregnant women, deserve clear and transparent information about prices in order to make the kind of good, personal decisions about the value of care, value that consumer-directed and high-deductible plans were originally designed to promote.