Reading the New York Times’ fantastic article on the sky-high cost of childbirth in the United States, I realized I was both perpetrator and victim of this situation.
You see, my wife is pregnant right now with our second son, due in September. And it’s not going to be cheap.
I can see the business model of the physicians and hospitals at work as they recommend scans and tests that are of questionable necessity. And yet, when it’s my own wife and son, it’s always easy to think of some terrible outcome that might be averted by just one more test.
“It’s amazing how much patients buy into our tendency to do a lot of tests,” Eugene Declercq, a Boston University professor who studies international variations in pregnancy, told the Times. “We’ve met the problem, and it’s us.”
I can’t deny that he’s right.
The Times article noted that in most other developed countries, midwives handle most of the work with pregnant moms, including prenatal visits and uncomplicated births. In the United Kingdom, 68 percent of births are attended by midwives, compared with just 8 percent in the United States.
OBGYNs, who command much higher fees than midwives, step in only when the risks or needed skill level spikes up.
But my wife, Christina, sees an OBGYN once a month during the fist eight months of pregnancy and then once a week in the final month.
When Christina and I went in for an ultrasound at 18 weeks, we told the radiologist that our niece, born three years ago, had serious heart defects that required multiple surgeries at Riley Hospital for Children.
So even though he found the baby’s heart to be perfectly normal, he recommended and scheduled another ultrasound six weeks later with a pediatric specialist.
When Christina and I got home, we asked ourselves, "Why don’t they just wait to see if any warning signs develop, before doing another ultrasound?" We discussed canceling it, but in the end, we went. We figured it would be better to be prepared for big problems at the delivery, rather than not.
The outcome: No problems at all.
When Christina started having heart palpitations, her doctors referred her to a cardiologist, who ordered a heart monitor she wore for two weeks, and then a follow-up scan. All of it showed nothing, and the cardiologist simply told her to not over-exert herself.
Why couldn’t he have given that advice during the first consultation, then waited to see if it made any difference? Why didn’t we just do that and reject all the extra tests? I guess because we worried there might be something more serious at work.
This past Sunday, Christina woke up at 4 a.m. with painful contractions. The same thing had happened twice when she was pregnant with our first son, and we were determined not to take another needless trip to the maternity triage unit at the hospital.
We phoned the OBGYN on-call, telling him this had happened before and that Christina had been prescribed a drug to calm the contractions. He said he couldn’t prescribe the drug without examining her. He said we could either come into the hospital for a few tests or wait it out by resting and drinking lots of water. We decided to wait it out.
But when the contractions hadn’t stopped after 12 hours, we finally decided to go in.
The hospital performed yet another ultrasound (the third one this pregnancy), and various other tests. All showed nothing of concern. In the end, the doctor sent us home with the advice to rest and take a double dose of Tylenol PM to help Christina sleep.
I walked away thinking, 'Why couldn’t the doctor have simply spent a few more minutes talking on the phone, and just recommended more Tylenol PM to help sleep through the pain?" That would have saved his time and our money.
But the problem is that no one in our scenario had any financial incentive to do otherwise: not the doctor, not the hospital, and not us.
The doctor, who in our case is employed by an independent physician practice, gets paid based on relative value units—the more he generates, the higher his pay—or, at the very least, the greater his leverage for pay the next time his contract is renegotiated.
On top of that, OBGYN physicians have the highest medical malpractice claims, so it’s always in their interest to order as many tests as possible to avert a terrible outcome—and a potential lawsuit.
The hospital has all the same incentives.
And for Christina and me, the cost of just the standard OBGYN visits and delivering the baby at the hospital—even a vaginal delivery with no complications at the cheapest hospital in town—will cost more than the maximum out-of-pocket exposure we have on our health plan with Anthem Blue Cross and Blue Shield.
So no one has any incentive in that situation to take the cautious route, to choose to go with less care based on the most likely outcome—that everything is fine. As a result, we go along with more and more care, and higher and higher costs.
Problem is, the bills do add up—for Anthem and for IBJ. Our premiums are 25 percent higher now than they were in 2009, when Christina was pregnant with our first son. And we’ll pay a deductible of $5,950—nearly 20 percent more than last time.
All of us—doctors, hospitals and patients—have met the problem. It’s us.