American parents, then, are paying more and more for prenatal services and getting less and less for their money. Because they have not banded together to demand any change to this status quo, it stands to reason that they’re paying for a service that they consider satisfactory. That je ne sais quoi is most likely comforting personalized attention, or what researchers call “high-touch” prenatal care.
According to Gerard Anderson, the director of the Center for Hospital Finance and Management at Johns Hopkins, the maternal-care system is designed with a well-insured, high-earning woman in mind. It’s assumed that since the typical patient will only experience one or two pregnancies over the course of her life, she will want cutting-edge, high-touch care—and won’t mind paying out of pocket for her share of that. Indeed, she may even expect to. “We’re not having very many babies,” he told me, “so we want it to be a really pleasant experience.”
Rebekah Tilley, a freelance writer who lives in Iowa, has had four children. All of her births were low-risk and none presented any serious complications. The prices of them ranged from free (one in Denmark, with socialized medicine, and one in Minnesota, with Medicaid) to well over $1,000 (one in Kentucky, with conventional insurance). Tilley’s favorite experience was in Iowa with her fourth child. Her family insurance plan cost $250 a month and covered everything, including her hospital stay. “I didn't even have a co-pay,” she says. That she knew her insurance would cover costs led her to agree to certain treatments, encouraged by her obstetrician, that were, she admits, “largely unnecessary.”
And, though her all-expenses-paid experience in Copenhagen was excellent, Tilley notes that the Danish system is much more low-tech and hands-off than what she was used to. She puts it in grocery-shopping terms: “It was like prenatal care at an Aldi, where you bag your own groceries and return your own cart, rather than a HyVee, where you can get pull-up service or order your groceries online.” The Danish practitioners offered fewer tests and procedures and expected her to carry her own paperwork with her. That’s partly why she preferred the American way—so long as she was comfortably and affordably insured.
Holly Noonan, who currently works at a dog-daycare center in Charleston, South Carolina, had two C-sections while teaching English in Turkey. “Private hospitals in Turkey overall are very clean and inexpensive, by U.S. standards,” she says. Moreover, “the price is great. I paid the equivalent of about $2,500 for my first son's C-section in 2007 and it wasn't much more for my second C-section in 2009.” But she chafed at the expectation that patients should assume much of the responsibility for their own care. “Not even two hours after my surgery I asked a nurse to hand me a blanket so I could nurse my baby and she told me it was not her job and I needed to do it,” she says. “She then scolded me for not having someone with me to help me.”