Yes, Childbirth Is More Expensive in the U.S. But You Get What You Pay For.

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July 1 2013 12:38 PM

Yes, Childbirth Is More Expensive in the U.S. But You Get What You Pay For.

The Canadian woman couldn’t get her first appointment for eight months, although it was free. The American got an appointment right away, but it cost a fortune.

A pregnant woman due in six weeks walks outside the State Department on August 5, 2010 in Washington, DC.
A pregnant woman due in six weeks walks outside the State Department in Washington, D.C. Would she fare better in Ottawa?

Photo by Tim Sloan/Getty Images

When Julie Bryant found out she was pregnant, she immediately called her best friend Laura Davis, who was a brand-new mom herself. Having a child was one more life adventure the two women would get to share, after both growing up in eastern Canada, attending the same college, moving to America to attend the same medical school, becoming physicians, and getting married. Yet geography now kept them apart: After medical school, Bryant, 35, had settled in New York City, while Davis, 34, had returned to Canada.

On the phone that day, Davis pressed her: “Will you come home to have the baby?”

Despite the lure of her friends and family there, Bryant’s answer was firm. “No,” she said, “I’ll get better care if I stay in the U.S. because I can pay for it.” Was she right? A New York Times story today says that in the U.S. many pregnant women face “sticker shock” because charges for delivering a baby have tripled since 1996, making them the highest in the world. The story also posits that the increased costs don’t translate into more or better services. But that’s not exactly the experience of these two friends.

In Newfoundland, the province both women are from, the health care system is 100 percent public. Everyone gets the same access and the same care for free. You literally can’t pay for service because there are no private doctors. You also must be referred to see a specialist by your family doctor; you can’t contract with one directly for an appointment.

When Davis discovered that she was 10 weeks pregnant, she went to her regular doctor to get a referral to an OB-GYN. She was a healthy woman with a normal pregnancy, so her specialist visit was not prioritized by the system. It was so low a priority, in fact, that the first available OB-GYN appointment was when she was eight months pregnant. This is the norm, according to Davis. Until you’re a few months away from your due date, you’re seen by only your general practitioner. A study conducted in 2012 by the Fraser Institute, a leading Canadian public policy think tank, found that the median wait time in Newfoundland across all specialties from a patient’s initial visit with a general practitioner to treatment by a specialist is 26.8 weeks. “The problem is wait times,” Davis says. “Even if you have money, you can’t buy a faster appointment. If you have a high-risk pregnancy, you would get in a lot quicker, but for a normal one, you probably wouldn’t get in until your last trimester.”

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Davis managed to work the system, but only because she is a doctor herself. She was able to “make a few calls” and get in to see an OB whom she knew, after only a few weeks of waiting. It also likely helped that she developed some minor health issues that needed to be addressed, bumping her up on the wait list. The average woman could potentially work the system if she was insistent enough, but Davis had the advantage of being able to personally call the physician’s secretary to secure her appointment.

For the duration of her pregnancy, Davis visited her OB every few weeks. Each time, she would spend about an hour in the waiting room for a 10-minute visit. If she had concerns or questions between visits, she could either call the doctor’s secretary or go to the walk-in case room of the local hospital, a triage area set up like an emergency room for pregnant women who need to see a doctor. There, she could see a nurse until the resident doctor on call was available, which would take about an hour. To see an attending physician at all, she would have to be in actual labor or have a serious issue, and the wait would be several hours. Still, she was one of the lucky ones.

Meanwhile, on the other side of border, Bryant found herself navigating a very different health care system. Bryant, then 34, initially chose to see a practitioner at a clinic that accepted her insurance. “But she never remembered anything about me from visit to visit,” Bryant recalls. “She spent no more than three minutes during our appointments.”

The lack of attention became more than a mere nuisance when Bryant began throwing up so profusely that she couldn’t keep down water. After repeated attempts to reach the doctor through her answering service, Bryant finally got a call from a different doctor “who sounded like she was at a nightclub.” This new doctor told her that she was sick because she was pregnant.