Maternity care costs are significantly higher for racial and ethnic groups

Maternity care costs are significantly higher for racial and ethnic groups

A new study today inJama Health Forumis the first to show that black, Hispanic and Asian people with private insurance tend to pay more off the table for maternity care than white people.

“The average additional postpartum pregnancy medical expenses paid by black, Hispanic and Asian people is significantly more than whites,” said Dr. Rebecca Gourevitch, the study's senior author and assistant professor in the Department of Health and Management at the University of Maryland School of Public Health (UMD SPH).

"We found that out-of-pocket costs were highest for Black people through pregnancy, delivery and postpartum. The study shows another possibility that people from different racial and ethnic groups have different experiences with maternity care. And the burden of more out-of-pocket costs could really impact maternal health."

The disparities were most pronounced during pregnancy: For recommended prenatal care services, black people paid an average of 74% more, Hispanic people paid 51% more, and Asian people paid 4% more than white people, the study found. At delivery and after birth the differences were smaller. Overall, blacks and Hispanics' maternity care utilization costs were a significantly higher proportion of their household income.

Led by researchers at UMD SPH and Harvard Th Chan School of Public Health, expenditures were measured for over 87,000 pregnancies, deliveries and the first 42 days postpartum. Researchers reviewed five years (2018-2022) of anonymized data from Blue Cross Blue Shield of Massachusetts (BCBSMA). Researchers measured spending in dollars and as a percentage of median household income in the member's area. Over a quarter (26.9%) of pregnancies were in areas with a median household income of $75,000 or less.

Blue Cross has long prioritized closing health care disparities and improving care for all. We conducted this study to understand a potential contribution to long-standing disparities in maternal health outcomes as a basis for designing solutions that make care more equitable. “

Dr. Mark Friedberg, senior vice president of performance measurement and improvement at Blue Cross and study coauthor

Gourevitch says the spending differences are largely due to coin insurance rates. Master insurance is the percentage of the cost of a medical service that the patient must pay after paying their plan's annual self-care amount. Black or Hispanic people are more likely to be enrolled in insurance plans that have high levels of advance insurance above 10%.

"Overinsurance often applies only to hospital care. However, for high-cost services such as delivery, 10% or more of the cost of hospitalization can be a lot," said Anna Sinaiko, senior author and associate professor of health economics and policy at Harvard's The Chan School of Public Health.

Some states, including Massachusetts, are considering legislation to eliminate maternity care costs, according to the Boston Globe. Based on their findings, Gourevitch and Sinaiko say these types of policy changes would have the greatest impact on Black and Hispanic people, who face the highest costs.

“Our results show that health insurance companies, employers and policymakers have an opportunity to reduce costs for all pregnant and postpartum people and reduce cost disparities by changing the way health insurance plans are designed,” Gourevitch said.

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