COLLEGE PARK, MD – A new study out today in JAMA Health Forum is the first to show that Black, Hispanic and Asian people with private insurance tend to pay more out-of-pocket for maternity care than white people.
"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 an assistant professor in the Department of Health Policy 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 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."
Differences 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 study found. At delivery and postpartum, disparities were smaller. Overall, Black and Hispanic people's out-of-pocket costs on maternity care were a significantly higher proportion of their household income.
Led by researchers at UMD SPH and the Harvard T.H. Chan School of Public Health, the study measured out-of-pocket spending in over 87,000 pregnancies, deliveries and the first 42-days postpartum. Researchers reviewed anonymized data from Blue Cross Blue Shield of Massachusetts (BCBSMA) over five years (2018-2022). The researchers measured out-of-pocket 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 inequities in health care and helping improve care for everyone. 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 & improvement at Blue Cross and study coauthor.
Gourevitch says that spending disparities are in large part driven by coinsurance rates. Coinsurance is the percentage of the cost of a medical service that the patient must pay, after they have paid their plan's annual deductible amount. Black or Hispanic people are more likely to be enrolled in insurance plans that have high coinsurance levels, 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 the hospitalization can be a lot," said Anna Sinaiko , study senior author and associate professor of health economics and policy at Harvard's TH Chan School of Public Health.
Some states, including Massachusetts, are considering legislation to eliminate out-of-pocket costs for maternity care, according to the Boston Globe . Based on their findings, Gourevitch and Sinaiko say this kind of policy change would have the largest impact on Black and Hispanic people, who face the highest costs.
"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.
