Childbirth costs: high, higher, highest

Gregory Nemec

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Childbirth is the number-one reason people are hospitalized in this country. So it is all the more significant that, when health economist Xiao Xu looked at the costs associated with normal, uncomplicated deliveries, she found eye-opening cost disparities.

Xu and colleagues at the School of Medicine analyzed data on 267,120 births in 463 hospitals. They found a range of $1,183 to $11,819 for vaginal births (with a mean of $4,192). For cesarean sections, the range was $1,249 to $13,688 (with a mean of $6,945). “It’s a big difference,” says Xu, “and given that we were looking at a low-risk, relatively homogeneous population, the range of variation was surprising.”

Writing in the July issue of Health Affairs, the researchers offered at least a partial explanation. Xu’s team had probed the 2011 Nationwide Inpatient Sample (NIS), a federal database. They found that hospitals with higher rates of C-sections and serious maternal morbidity had significantly higher facility costs for low-risk deliveries. They also documented an association between costs at the higher end of the spectrum and hospitals that were in rural areas, performed relatively few deliveries, had a low proportion of childbirths covered by Medicaid, or had non-federal-government or nonprofit ownership.

But these hospital characteristics, Xu points out, accounted for only 13 percent of the cost variation. Moreover, some of the variations could be due to the costs of doctors or baby care—factors the NIS numbers didn’t take into account. Her team is beginning to examine those costs, as well as such factors as hospital protocols and procedures, to try to find the reasons for the ups and downs. “With nearly four million births a year,” says Xu, “we have the potential to identify ways we might make a huge impact on overall health-care costs without compromising quality.”