Steve Calvin M.D. on pregnancy care, health care reform, and innovation

The cost of having a baby in the United States

We are never going to get anywhere in improving the value of healthcare without knowing specifically what the costs are for those paying the bills.  Harold Miller is one of the most persistent and perceptive advocates for real positive change in healthcare.  A very important new study on pregnancy care costs was commissioned by his organization, The Center for Healthcare Quality and Payment Reform, along with Childbirth Birth Connection and Catalyst for Payment Reform.  It is available here:

This study reveals the real dollar amounts PAID for care by employers/insurers, government programs, and from patients out of pocket.  This information cuts through the “confusopoly” I have mentioned before.  It even shows that the insurers and the providers are as confused as anyone else.  The average total commercial insurer payments for all maternal and newborn care for vaginal and cesarean section delivery were $18,329 and $27,866 respectively.   The numbers for Medicaid were $9,131 and $13,590.  With four million births per year in the US more than $50 billion dollars are spent on pregnancy care.

From my perspective there are four major highlights of the study.  First, is the finding that facility fees make up well more than 1/2 of the total cost.  Second, is that 3/4 of the total cost occurs at the time of delivery.    Third, is that normal newborn care averages $4400.  Fourth, and probably most important, the high cost of cesarean birth for mother and baby is amplified by the fact that we have an unnecessarily high cesarean section rate (of 33%).  Besides hand wringing over these numbers there are some things that can be done.

Harold has been a mentor and advocate for the work that we are doing here in Minnesota to develop and test what Amy Romano CNM and others from Childbirth Connection call a “pregnancy care and delivery home” (PCDH).   With an insurance company partner we will soon be testing a PCDH model for low-risk mothers on Medicaid.  It will be for mothers who choose midwife-directed birth center care and it includes continuity of care with basic CNM and OB physician professional services in the hospital – all for a single price.

We will be studying the outcome of our pilot with our insurance partner and colleagues at the School of Public Health at the University of Minnesota.  Our model is designed using the recommendations of Childbirth Connection (  Their Transforming Maternity Care Partnership and Evidence-Based Maternity Care resources lay out a clear path to pregnancy care that is higher quality, more satisfying, and less costly.