"American Way of Birth, Costliest in the World"

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    "American Way of Birth, Costliest in the World" (NY Times)

    Wow, according to this article giving birth in the U.S. is 2-3x more expensive than in other countries (2012 average of ~$10,000 for conventional delivery and ~$15,000 for C-section) and women tend to be discharged as quickly as possible since insurance only pays for the bare minimum hospital stay.

    I'm just a student (so no experience with how insurance or lack thereof affects care in a hospital setting) but I'm wondering: what happens when someone going into labor has no insurance at all? I know Medicaid kicks in at some point, but the article mentioned that "many doctors refuse to take patients covered under the program." That doesn't seem particularly ethical to me but is that a common occurrence in hospitals? Could an uninsured woman actually in labor be turned away for lack of insurance? I apologize for my ignorance, I'm just really curious as to how this works.

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  2. 14 Comments...

  3. 3
    They show up at your local Emergency Department where they cannot be denied care.....that is called EMTALA...http://www.emtala.com/faq.htm....and COBRA.......then transferred to OB unit/MD


    The Emergency Medical Treatment and Active Labor Act is a statute which governs when and how a patient may be (1) refused treatment or (2) transferred from one hospital to another when he is in an unstable medical condition.

    EMTALA was passed as part of the Consolidated Omnibus Budget Reconciliation Act of 1986, and it is sometimes referred to as "the COBRA law". In fact, a number of different laws come under that general name. Another very familiar provision, also referred to under the COBRA name, is the statute governing continuation of medical insurance benefits after termination of employment.

    EMTALA is Section 1867(a) of the Social Security Act, within the section of the U.S. Code which governs Medicare.

    EMTALA applies only to "participating hospitals" -- i.e., to hospitals which have entered into "provider agreements" under which they will accept payment from the Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS) under the Medicare program for services provided to beneficiaries of that program. In practical terms, this means that it applies to virtually all hospitals in the U.S., with the exception of the Shriners' Hospital for Crippled Children and many military hospitals. Its provisions apply to all patients, and not just to Medicare patients. (See Section 15 below.)

    The avowed purpose of the statute is to prevent hospitals from rejecting patients, refusing to treat them, or transferring them to "charity hospitals" or "county hospitals" because they are unable to pay or are covered under the Medicare or Medicaid programs. This purpose, however, does not limit the coverage of its provisions -- see Sections 15 and 16 below.

    EMTALA is primarily but not exclusively a non-discrimination statute. One would cover most of its purpose and effect by characterizing it as providing that no patient who presents with an emergency medical condition and who is unable to pay may be treated differently than patients who are covered by health insurance. That is not the entire scope of EMTALA, however; it imposes affirmative obligations which go beyond non-discrimination. See Section 16 below.
    Emergency Medical Treatment & Labor Act (EMTALA)
    In 1986, Congress enacted the Emergency Medical Treatment & Labor Act (EMTALA) to ensure public access to emergency services regardless of ability to pay. Section 1867 of the Social Security Act imposes specific obligations on Medicare-participating hospitals that offer emergency services to provide a medical screening examination (MSE) when a request is made for examination or treatment for an emergency medical condition (EMC), including active labor, regardless of an individual's ability to pay. Hospitals are then required to provide stabilizing treatment for patients with EMCs. If a hospital is unable to stabilize a patient within its capability, or if the patient requests, an appropriate transfer should be implemented.
    http://www.cms.gov/Regulations-and-G...irect=/emtala/
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    It is great that somebody brought up EMTALA...I wonder-just some extrapolation here. The "nuts" in state congress around the country that are trying to prevent women from access to health care if they need it in relation to an abortion (and multiple other services)-I believe Ohio has created a "non-transfer" statute....do they not realize that EMTALA exists?
    Not_A_Hat_Person likes this.
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    Women show up with no prenatal care and no insurance all the time and they receive care. OBs don't like it, and who can blame them. I don't enjoy working without pay, I don't blame them for balking at it. And there are risks, too. No prenatal care means the possibility of unpleasant surprises with possible legal risks. Surprise! Mom's addicted to narcotics, better hope she's honest if you need to give the baby Narcan. Surprise! It's twins, and there wasn't time for an ultrasound prior to delivery, so the doctor "gets" to do a breech vaginal delivery (witnessed this). Surprise! She told you she was 39 weeks, but she's really only 28 weeks, and there wasn't time for an ultrasound to find out. Better hit the code button! Women avoid prenatal care for many reasons. Lack of transportation, lack of understanding about Medicaid, lack of knowledge, the urge to avoid social workers. They usually do manage to show up at the hospital for delivery (pain can be a great motivator).

    As for quick discharge, yes it does happen some places. Some states have enacted statutes that require insurance companies to pay for minimum stays for maternity care. I'm a huge fan of these laws. I remember sending a 16 year old home, breastfeeding, 12 hours after delivery in the days of drive thru deliveries. I went home and prayed fervently for the safety of her and that baby.
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    I work at a busy urban hospital's postpartum unit. I don't see hardly anyone leave before two nights with a vag delivery and three for a section. Anyone who leaves early only does so by their own request and people are itching to get out either way. I don't see many moms who didn't get any prenatal care, and for those who were late to seek care we screen their babies for drug exposure.

    I also don't like working for free and can't blame the OBs for not liking it either. However those with no insurance are regularly my patients, both on the OB and the GYN side. I'm not sure if my hospital is unique but one thing I'm sure of is that folks like trashing on the American healthcare system. Thanks a lot... For how hard I work I make a pittance in my paycheck.
  7. 1
    Quote from RNmo
    I work at a busy urban hospital's postpartum unit. I don't see hardly anyone leave before two nights with a vag delivery and three for a section. Anyone who leaves early only does so by their own request and people are itching to get out either way. I don't see many moms who didn't get any prenatal care, and for those who were late to seek care we screen their babies for drug exposure.

    I also don't like working for free and can't blame the OBs for not liking it either. However those with no insurance are regularly my patients, both on the OB and the GYN side. I'm not sure if my hospital is unique but one thing I'm sure of is that folks like trashing on the American healthcare system. Thanks a lot... For how hard I work I make a pittance in my paycheck.
    I was proud of what I did when I worked in L&D. I worked in a regional center. We had lots of patients without insurance and prenatal care, and they were treated just like everyone else (except for the social work consult). I do think things could be better, though. Where I'm at, there are NO birthing centers, less than 100 CNMs practicing in the state, and no legal means of having an attended homebirth. The MD lobby has things locked up nice and tight, to the detriment of patients. Patients who are low risk should have more options. It would save everyone money, and the c section rate would probably drop.
    klone likes this.
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    http://suite101.com/article/explorin...-state-a339076

    This is just one set of statistics from 2002 - 40% of childbirths are paid for by Medicaid. I have seen another one but I couldn't find it just now that says it is around 60% which I would tend to believe would be more accurate since the economy has soured.

    This is a topic that I have wondered about as well and concerns me. I had insurance for the birth if my 2 kids but by the skin of my teeth, so to speak. I went back to work when they were 3 weeks old because I didn't want to jeopardize my job and lose the insurance, which DOUBLED when I added my infant.

    I have since met many sAHM's who get medicaid for their multiple planned pregnancies and they seem to have no problem with it. I guess I went about it all wrong. WTH.

    Oh and I forgot. If the mom gets Medicaid for prenatal and L&D the baby automatically gets it for the first year of life.
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    Last edit by DoGoodThenGo on Jul 3, '13 : Reason: Content Added
  10. 2
    Childbirth cost more in the United States for the same reasons most everything else healthcare related does: our system rewards financially the more things are *done* to a patient.

    It is the almost exactly the same as cable television, airlines, and pretty much everything else in America these days; you pay for each little thing never mind at one time it once came bundled together at a lower price.

    Also lone among developed Western nations the United States continues to treat pregnancy along with L&D as a *disease* that requires physicians. In other countries low risk vaginal births are attended to by midwives who also oversee much prenatal and post natal care. Whereas home births here are frowned upon, they are common enough for low risk patients elsewhere.
    klone and morte like this.
  11. 0
    One big factor in medicalizing childbirth is lawsuits. There's a reason many OBs say "You get sued for the Cesarean you didn't do."


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