A new study published today in the JAMA Health Forum reveals a significant disparity in out-of-pocket costs for maternity care among racial and ethnic groups, with Black, Hispanic, and Asian people with private insurance typically paying more than their white counterparts.
“The average additional spending on medical care from pregnancy through postpartum paid by people who are Black, Hispanic, and Asian is significantly more than white people,” said Dr. Rebecca Gourevitch, the study’s lead author and assistant professor in the Department of Health Policy and Management at the University of Maryland School of Public Health (UMD SPH).
The study highlights that Black people, in particular, incur the highest out-of-pocket costs across the pregnancy, delivery, and postpartum periods. “We found that out-of-pocket costs were highest for Black people overall through pregnancy, delivery, and postpartum. The study shows yet another way that people from different racial and ethnic groups are having different experiences of maternity care. And the burden of greater out-of-pocket costs could have a real impact on maternal health,” said Dr. Gourevitch.
Disparities were most pronounced during pregnancy. For recommended prenatal care services, Black people paid, on average, 74% more, Hispanic people 51%, and Asian people 4% more than white people. The disparities were smaller at delivery and postpartum. Overall, Black and Hispanic people’s out-of-pocket costs were a significantly higher proportion of their household income.
Led by researchers from UMD SPH and the Harvard T.H. Chan School of Public Health, the study analyzed out-of-pocket spending in over 87,000 pregnancies, deliveries, and the first 42 days postpartum. The researchers reviewed anonymized data from Blue Cross Blue Shield of Massachusetts (BCBSMA) spanning five years (2018–2022). The study measured out-of-pocket spending in both dollar amounts and as a percentage of median household income in the member’s area. Over a quarter (26.9%) of pregnancies occurred in areas with a median household income of $75,000 or less.
Blue Cross, which has long been dedicated to addressing inequities in healthcare, collaborated on this study to understand one potential contributor to longstanding disparities in maternal health outcomes, aiming to develop solutions to create more equitable care. “We undertook this study to understand one potential contributor to longstanding inequities in maternal health outcomes as a basis for designing solutions that make care more equitable,” said Dr. Mark Friedberg, senior vice president of performance measurement and improvement at Blue Cross and co-author of the study.
The researchers identified that the disparities in spending are largely driven by coinsurance rates. Coinsurance refers to the percentage of medical service costs that a patient must pay after meeting their annual deductible. Black and Hispanic people are more likely to be enrolled in insurance plans with high coinsurance levels, typically above 10%. “Coinsurance often only applies to care provided in the hospital. But for high-cost services like a delivery, paying 10% or more of the cost of hospitalization can be a lot,” said Anna Sinaiko, senior author of the study and associate professor of health economics and policy at Harvard’s T.H. Chan School of Public Health.
Some states, including Massachusetts, are considering legislation to eliminate out-of-pocket costs for maternity care. Based on the study’s findings, Gourevitch and Sinaiko argue that such a policy change would most benefit Black and Hispanic people, who face the highest out-of-pocket expenses.
“Our results reveal that health insurance companies, employers, and policymakers have an opportunity to lower out-of-pocket costs for all pregnant and postpartum people and to reduce disparities in costs by changing how health insurance plans are designed,” said Gourevitch. This potential policy shift could help alleviate the financial burden on families and reduce disparities in maternal health care costs.
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