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    How much does it cost to have a baby in the United States?



    Dr Pettker is an Associate Professor of Maternal-Fetal Medicine in the Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut. He is also a member of the Contemporary OB/GYN editorial board.

    Last year the US Department of Agriculture estimated that it would cost a middle-income couple just over $245,000 to raise a child to the age of 18.1 Admittedly, these costs varied. For instance, costs for low-income rural families are about $145,000, while those for high-income families in Northeast urban areas are estimated at $455,000. These assessments don’t include the cost of college, but they include housing, food, childcare, education through high school, and other expenses. When I read this information I was as surprised by the number as I was by the fact that this has been estimated annually since 1960!

    However, as an obstetrician I found it particularly interesting that these expense estimates did not include the cost of pregnancy and childbirth, which certainly is an important part of “raising a child.” The most obvious reason for this oversight is that the Department of Agriculture is trying to account for the costs of raising a child from birth, rather than from conception. However, looking deeper, it becomes clearer that the complexity of our healthcare finance system makes adding this estimate quite challenging. For instance, would the actuaries use the cost of the insurance to cover the pregnancy or the costs paid by those insurance companies for perinatal care? Furthermore, do we actually know the true costs of perinatal care in the United States?

    I became familiar with the difficulty in determining these costs when a patient from overseas came to my practice this year requesting an itemization of the costs she would be asked to pay for her prenatal care and birth, assuming a routine, uncomplicated pregnancy. We went to our practice and hospital administrators to determine the actual costs for ultrasounds, prenatal visits, and hospitalization for someone who was not indigent. We arrived at an answer after a great deal of investigation, but it was a bit shocking that such sophisticated businesses could find it as challenging as it was. I would encourage you to ask the question at your own center. For me, it was a true-life demonstration of what I had read in the popular press regarding the enigmatic and highly variable process for determining charges versus actual cost estimates for common procedures such as hip replacements and colonoscopies.2


    Christian M. Pettker, MD
    DR. PETTKER is Assistant Professor, Department of Obstetrics, Gynecology and Reproductive Sciences, Yale-New Haven Hospital, New Haven, ...


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