New Parents Risk Financial Burden Because of the Costs of Pregnancy and Delivery, Study Finds
Researchers say some low-income families spend nearly 20 percent of annual income on medical costs during the year of pregnancy and birthing
Birthing parents risk being financially burdened by the out-of-pocket medical costs of pregnancy and delivery, which cost some low-income parents close to 20 percent of their annual income, according to a Mount Sinai-led study published in the journal Obstetrics and Gynecology on March 10.
The study found that birthing parents were at a higher risk of medical spending that would create a financial burden than similarly situated people who were not pregnant. Birthing parents also reported higher rates of unemployment and high rates of gaining and losing Medicaid in the delivery year. Low-income birthing parents had the highest risk of catastrophic health expenditures, or out-of-pocket payments for health care that exceeded 10 percent of family income in a given year. These families spent as much as about 19 percent of household income on health care expenses, or nearly 30 percent when health insurance premiums were included in spending.
Public health insurance, including Medicaid, was associated with starkly lower risks of burdensome health costs than private insurance—particularly when health insurance premiums were included in spending—for birthing parents with low incomes. Implementation of the Affordable Care Act did not significantly change the risk of catastrophic spending for parents.
“Pregnancy and delivery are critical periods of time with high health care utilization. Our study demonstrates that this health care utilization can be a financial burden for expectant parents,” said corresponding author Jessica A. Peterson, MD, Maternal Fetal Medicine Fellow in Obstetrics, Gynecology, and Reproductive Science at the Icahn School of Medicine at Mount Sinai. “This burden primarily affects those at lower incomes, especially if they have private insurance.”
The retrospective, cross-sectional study of the Medical Expenditure Panel Survey from 2008 to 2016 examined the prevalence, trends, and risk factors for catastrophic health expenditures in the year of delivery among birthing parents. The team of researchers identified more than 4,000 birthing parents of newborns and a 2:1 matched cohort of nearly 8,000 women who were reproductive age but not pregnant. Researchers then assessed for health care spending that was more than 10 percent of the family income during the year.
The study findings will be used to further discussions about significant reform to public health policies and safety net health care. “Given the association between pregnancy, delivery and catastrophic health expenditure—as well as the protective effects of public insurance—it is imperative that we create policies that not only ensure insurance coverage for pregnant people, but also make it affordable,” Dr. Peterson said. “Possible avenues to improve access to affordable health insurance include Medicaid expansion, as well as regulation of insurance cost-sharing and benefit designs.”
Benjamin B. Albright, MD, MS, and Haley A. Moss, MD, MBA, from the Department of Obstetrics and Gynecology at Duke University Medical Center also contributed to this research. The study was supported in part by funding from the National Institutes of Health (BIRCWH K12HD043446).
About the Mount Sinai Health System
Mount Sinai Health System is one of the largest academic medical systems in the New York metro area, with 48,000 employees working across eight hospitals, more than 400 outpatient practices, more than 600 research and clinical labs, a school of nursing, and a leading school of medicine and graduate education. Mount Sinai advances health for all people, everywhere, by taking on the most complex health care challenges of our time—discovering and applying new scientific learning and knowledge; developing safer, more effective treatments; educating the next generation of medical leaders and innovators; and supporting local communities by delivering high-quality care to all who need it.
Through the integration of its hospitals, labs, and schools, Mount Sinai offers comprehensive health care solutions from birth through geriatrics, leveraging innovative approaches such as artificial intelligence and informatics while keeping patients’ medical and emotional needs at the center of all treatment. The Health System includes approximately 9,000 primary and specialty care physicians and 11 free-standing joint-venture centers throughout the five boroughs of New York City, Westchester, Long Island, and Florida. Hospitals within the System are consistently ranked by Newsweek’s® “The World’s Best Smart Hospitals, Best in State Hospitals, World Best Hospitals and Best Specialty Hospitals” and by U.S. News & World Report's® “Best Hospitals” and “Best Children’s Hospitals.” The Mount Sinai Hospital is on the U.S. News & World Report® “Best Hospitals” Honor Roll for 2024-2025.
For more information, visit https://www.mountsinai.org or find Mount Sinai on Facebook, Twitter and YouTube.