Minority Groups Spent More on Maternity Care Than White Patients
Researchers explored out-of-pocket spending on maternity care and classified their findings by race and ethnicity.
Asian, Black, and Hispanic patients with commercial insurance spent significantly more on out-of-pocket maternity care than White patients, according to data published in JAMA Health Forum.1 Driven by enrollment in plans with high coinsurance, researchers believe modifications to benefit design are necessary to address this disparity.
“Black and Hispanic birthing people have lower rates of adequate prenatal care and are more likely to deliver at lower-quality hospitals than White birthing people,” wrote authors of the study. “Less is known about whether out-of-pocket (OOP) spending during maternity care differs by race and ethnicity. Differences in spending could be a promising target for intervention because they are directly influenced by insurance benefit design.”
The Affordable Care Act was designed to offer financial relief to patients in need of essential maternal care services. Despite those legislative provisions, average OOP spending was $3070 for birthing individuals with commercial insurance from the year 2018 to 2020.1 In a similar time period, 1 in 6 families’ OOP spending for maternal care reached over $5000, according to data published in Pediatrics.2
Researchers explored maternity episodes by birthing peoples’ race and ethnicity from January 1, 2018, to December 31, 2022. | image credit: Pcess609 / stock.adobe.com
“OOP costs can be barriers to use of health care services,” they wrote.1 “Giving birth increases the likelihood of having catastrophic health care expenditures and problems paying medical bills, particularly among patients with pregnancy complications or who are in low-income groups and may increase challenges paying for other basic household expenses.”
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As researchers of the current study noted, addressing disparities in patients’ OOP spending can have significantly beneficial impacts on the equity of health care in the US. With little known about the full extent of OOP costs for maternity care, researchers investigated the differences of spending across race and ethnicity.
They conducted their review using Blue Cross Blue Shield of Massachusetts data regarding OOP spending during maternity episodes by birthing peoples’ race and ethnicity from January 1, 2018, to December 31, 2022.1
“Due to long-standing historical differences in income by race and ethnicity in the US, we explore differences in OOP spending both as a total and a percentage of median census-tract household income,” continued the authors. “We also examine differences in OOP spending by part of the maternity episode and by type of cost sharing, as well as differences in benefit design across racial and ethnic groups.”
Researchers included a sample of 87,253 maternity episodes consisting of 76,826 unique patients (mean age, 32.4 years). Across all maternity episodes, 9.8% of birthing persons were Asian, 3.8% were Black, 7.9% were Hispanic, and 78.5% were White. Comparable to that of the population where the study was conducted, the racial and ethnic composition of the researchers’ sample was similar to commercially insured patients living in New England and Massachusetts.1
Amongst the 4 races explored in the study, patients who were Black ($2398) and Hispanic ($2300) had higher OOP spending than birthing people that were Asian ($2202). However, White birthing people had the lowest mean OOP spend at just $2036 throughout the study period. When compared with participants who were White, Asian birthing people spent 8.1% more in OOP costs, Black people spent 17.7% more, and Hispanic people spent 12.9% more.
“In this cross-sectional study of a commercially insured population, there were significant differences in OOP spending for maternity episodes by race and ethnicity,” they continued.1 “White birthing people incurred the lowest OOP spending, and Black birthing people had the highest OOP spending, both overall and as a percentage of the median household income in their census tracts. Although the level of OOP spending was higher during delivery than the prenatal period, the differences in OOP spending by race and ethnicity were larger during the prenatal period.”
Another notable finding was that deductible payments were responsible for more than 50% of all OOP spending. However, as enrollment in health plans with high coinsurance is more common amongst Black and Hispanic birthing people, researchers agreed that coinsurance was the main driver of racial and ethnic disparities in spending. With coinsurance rates and deductibles seemingly going through the roof for minority groups in the US, insurers and payers are being looked at to rethink the way benefit plans are designed and distributed.
“Changes to benefit design could reduce OOP spending and differences across racial and ethnic groups. To the extent that exposure to high OOP costs can impact maternal health, these health insurance benefit design changes could offer a pathway to improving health equity,” concluded the study authors.1
READ MORE: Women's Health Resource Center
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