Maternity care out-of-pocket costs higher for Black patients

It costs a Black person $350 more to have a baby than a White person, according to a recent JAMA Health Forum study illuminating racial health disparities in out-of-pocket costs.

Overall, it costs a Black person $2,398 in out-of-pocket spending for maternal healthcare compared to $2,036 for a White person, the analysis showed. The high out-of-pocket costs for maternal healthcare are worrisome, the researchers said, because they could force patients to choose between healthcare access and other basic needs, like food or housing.

These findings echo other maternal health disparities. The United States is home to the worst maternal health inequity in the developed world, per previous research from the Commonwealth Fund, with Black people being about three times more likely to die of a pregnancy-related issue compared to their White peers.

This latest study highlights disparities that extend beyond outcomes. Overall, Black and Hispanic people face higher out-of-pocket costs for pregnancy and childbirth than White people.

Using data from Blue Cross Blue Shield of Massachusetts from January 2018 to December 2022, the researchers examined out-of-pocket costs for pregnancies, deliveries, and 42-day postpartum care for around 87,000 pregnancies.

Black people had the highest out-of-pocket costs for their maternity care journey, followed by Hispanic people, who saw $2,300 in out-of-pocket expenses. For Asian people, the cost of a maternity episode was $2,202.

These differences were mostly driven by costs incurred during the prenatal period and costs related to coinsurance, the researchers said.

Black people spent 32.6% more and Hispanic people spent 16.9% more than White people during the prenatal period. Asian people actually spent 6.3% less than White people.

Similarly, Black people spent 74.4% more and Hispanic people spent 51.2% more on recommended prenatal care services than White people. Asian people spent 4.2% more than White people.

In terms of coinsurance, Black and Hispanic people were more likely to be enrolled in plans with high inpatient coinsurance than their White and Asian counterparts. This resulted in overall higher coinsurance costs, the data showed. While Black people paid $772 in coinsurance and Hispanic people paid $779, White people paid $511. Asian people typically saw $669 in coinsurance costs.

The researchers said these findings raise concern about overall maternal healthcare access, which consequently can impact maternal health outcomes.

"Cost sharing is a tool for reducing overuse of healthcare (moral hazard, in economic terms) by holding patients directly responsible for some of the cost of their care," they explained. "However, high out-of-pocket costs can lead to forgone or delayed healthcare services, even when they are high value, leading to worse health outcomes."

This is particularly salient with prenatal care, which the researchers explained is more easily left to the discretion of the patient. With Black and Hispanic patients more likely to incur higher costs for prenatal care, they might not access it.

"This raises the concern that these differential costs could contribute to racial disparities in utilization and, ultimately, health outcomes," the researchers said.

And it's not just care access that's impacted by high costs. The researchers noted that patients faced with high maternity care costs might be left deciding between healthcare and other basic needs, like food and housing. These are key social determinants of health affecting clinical outcomes, the experts said.

Indeed, out-of-pocket spending on maternity care for Black and Hispanic people took up a greater share of household income than for White people, the data showed. While maternity care costs accounted for 2.4% of household income for White people and 2.6% for Asian people, it was 4.1% for Black people and 3.6% for Hispanic people.

"If stakeholders aim to reduce the out-of-pocket cost burden of maternity care, our findings suggest that lower deductibles would have the greatest contribution to reducing out-of-pocket costs for all groups," the researchers offered as one solution. "However, lower coinsurance would have the largest impact on reducing differences across racial and ethnic groups."

The researchers concluded by urging more studies about the causes and implications of maternity care spending disparities.

Sara Heath has covered news related to patient engagement and health equity since 2015.