Study Reveals Racial and Ethnic Disparities in Maternity Care Spending: Black and Hispanic Individuals Face Higher Costs

Published: February 28, 2025

A new study published in JAMA Health Forum has revealed significant racial and ethnic disparities in out-of-pocket maternity care spending among individuals with private insurance. the research, analyzing data from over 87,000 pregnancies, deliveries, and postpartum periods, found that Black, Hispanic, and Asian individuals consistently pay more for maternity care than their white counterparts. These disparities are most pronounced during pregnancy, raising concerns about equitable access to healthcare and the potential impact on maternal health outcomes. The study highlights a critical issue: even with private insurance, racial and ethnic minorities bear a disproportionate financial burden when it comes to maternity care.

The study, conducted by researchers at the University of Maryland school of Public Health (UMD SPH) and the Harvard T.H. Chan School of Public Health, examined anonymized data from Blue Cross Blue Shield of Massachusetts (BCBSMA) spanning five years, from 2018 to 2022. The findings underscore a persistent problem within the healthcare system, where financial burdens disproportionately effect minority communities seeking essential maternity services. This research provides crucial data for policymakers and healthcare providers aiming to address these inequities.

Dr. Rebecca Gourevitch, the study’s lead author and an assistant professor at UMD SPH, emphasized the meaning of these findings. The average additional spending on medical care from pregnancy through postpartum paid by people who are Black, Hispanic and Asian is substantially more than white people, she stated. We found that out-of-pocket costs were highest for black people overall through pregnancy, delivery and postpartum. the study shows yet another way that people from different racial and ethnic groups are having different experiences of maternity care.And the burden of greater out-of-pocket costs coudl have a real impact on maternal health.

The disparities were most evident during pregnancy, specifically for recommended prenatal care services. the study revealed that black individuals paid an average of 74% more, Hispanic individuals 51% more, and Asian individuals 4% more than white individuals for these essential services.While the differences were smaller at delivery and postpartum, the overall financial strain on Black and Hispanic families was ample, with out-of-pocket costs representing a considerably higher proportion of their household income. This financial strain can lead to delayed or forgone care, potentially impacting both maternal and infant health.

The research team analyzed out-of-pocket spending both in dollar amounts and as a percentage of median household income in the member’s area. Notably, over a quarter (26.9%) of the pregnancies included in the study occurred in areas with a median household income of $75,000 or less,underscoring the potential financial vulnerability of many expectant families. This highlights the need for targeted interventions to support these families and ensure access to affordable maternity care.

Dr.Mark Friedberg, senior vice president of performance measurement and betterment at Blue Cross and a study co-author, explained BCBSMA’s motivation for supporting the research. Blue Cross has long prioritized closing inequities in health care and helping improve care for everyone. We undertook this study to understand one potential contributor to longstanding inequities in maternal health outcomes as a basis for designing solutions that make care more equitable, he said.

According to the study, coinsurance rates are a major driver of these spending disparities. Coinsurance refers to the percentage of the cost of a medical service that the patient is responsible for paying after meeting their plan’s annual deductible. Black and Hispanic individuals are more likely to be enrolled in insurance plans with high coinsurance levels, frequently enough exceeding 10%. This means that even with insurance, these individuals are paying a larger share of their maternity care costs.

Anna Sinaiko, study senior author and associate professor of health economics and policy at Harvard’s TH Chan School of Public Health, elaborated on the impact of coinsurance. coinsurance often onyl applies to care provided in the hospital. But for high-cost services like a delivery, paying 10% or more of the cost of the hospitalization can be a lot, she explained. This financial burden can be particularly challenging for low-income families, potentially leading to debt and financial instability.

The findings of this study have significant policy implications. Several states, including Massachusetts, are considering legislation to eliminate out-of-pocket costs for maternity care. Gourevitch and Sinaiko believe that such policy changes would have the most significant positive impact on Black and Hispanic individuals, who currently bear the brunt of these financial burdens. Eliminating these costs would improve access to care and reduce financial stress for expectant families.

Gourevitch concluded by emphasizing the need for systemic change. our results reveal that health insurance companies, employers and policymakers have an prospect to lower out-of-pocket costs for all pregnant and postpartum people and to reduce disparities in costs by changing how health insurance plans are designed, she stated. This call for action highlights the importance of addressing the root causes of these disparities and creating a more equitable healthcare system for all.

Maternity Care Costs: Unmasking the shocking racial Disparities in Healthcare Spending

“It’s unconscionable that in this day and age,a woman’s access to essential maternal healthcare is persistent by the color of her skin.”

Interviewer: Dr. Anya Sharma, leading expert in healthcare economics and disparities, welcome to World Today news.This recent JAMA Health Forum study reveals significant racial and ethnic disparities in maternity care spending; Black and Hispanic individuals face considerably higher costs, even with private insurance.can you elaborate on the key findings that surprised or concerned you most?

Dr.Sharma: Thank you for having me. The study’s findings, highlighting the disproportionate financial burden placed on Black and Hispanic individuals seeking maternity care, were deeply troubling, yet sadly, not entirely unexpected. What truly shocked me was the sheer magnitude of the disparity. We’re not just talking about minor variations; we’re seeing Black individuals paying, on average, 74% more for prenatal care than their white counterparts. This points to a systemic issue deeply entrenched within our healthcare system. These exorbitant costs are not just numbers; they represent real-world barriers to accessing critical prenatal, delivery, and postpartum care. The study shows the out-of-pocket expenses impact access and quality of maternal healthcare.

Interviewer: The study points to coinsurance rates as a major factor driving these disparities. Can you unpack the role of coinsurance in exacerbating these existing inequalities?

Dr. Sharma: Absolutely. Coinsurance, the percentage of medical costs a patient pays after meeting their deductible, acts as a significant amplifier of inequalities. The study found that Black and Hispanic individuals are disproportionately enrolled in plans with high coinsurance rates—frequently enough exceeding 10%. This means that even with insurance coverage,they’re responsible for a substantially larger share of the overall cost of maternity care. For instance, a 10% coinsurance on a $10,000 hospital delivery results in a $1,000 out-of-pocket expense – a substantial amount for many families, especially those already facing financial hardship. This creates a vicious cycle: high out-of-pocket costs lead to delayed or forgone care which, in turn, negatively impacts maternal and infant health outcomes.

Interviewer: The study mentions that discrepancies were most prominent during pregnancy, specifically for recommended prenatal care services. Why is prenatal care so disproportionately impacted by these cost disparities?

Dr. Sharma: Prenatal care is crucial for a healthy pregnancy and delivery; regular check-ups, screenings, and testing are vital. However, the frequency and types of appointments, plus necessary tests, often translate into higher overall costs leading to significantly higher out-of-pocket expenses for those with high coinsurance or limited financial resources. For minority groups burdened by higher coinsurance rates, the cumulative effect of these visits quickly compounds. This highlights the urgent need for financial assistance programs and policy changes to make quality prenatal care universally accessible irrespective of socioeconomic status or race.

Interviewer: What are some practical steps that policymakers, healthcare providers, and insurance companies can take to address these troubling inequities?

Dr. Sharma: Addressing this complex problem demands a multi-pronged approach.

Policy Changes: Implementing legislation to eliminate or significantly reduce out-of-pocket costs for maternity care, as some states are already considering, would be a major step forward. This would particularly benefit Black and Hispanic individuals, who disproportionately bear the financial burden. Expanding access to Medicaid and other government-provided healthcare programs is also crucial in reducing economic barriers.

Insurance Reform: Insurance companies must re-evaluate their coinsurance structures and pricing practices. Plans with excessively high coinsurance rates can quickly erode the affordability of maternity care for many families. Designing insurance packages that offer more predictable and affordable coverage will greatly improve access for all.

Targeted Financial Assistance Programs: Implement extensive financial assistance and support programs explicitly geared toward expecting mothers from marginalized communities. This may involve subsidies, grants, or dedicated funds to help offset the costs of prenatal care, delivery, and postpartum care, reducing the financial strain on vulnerable families.

Provider Education and Advocacy: Healthcare professionals must advocate for equitable patient care. Educating providers about these economic disparities is essential to ensuring patients receive comprehensive and culturally sensitive counsel about the costs and available financial resources.

Interviewer: What is the long-term impact of these cost disparities on maternal and child health?

Dr. Sharma: The financial strain of high out-of-pocket costs for maternity care has far-reaching consequences.It leads to delayed or forgone care, impacting both maternal and infant health, increasing risks of complications, and negatively impacting long-term maternal health. Late or no prenatal care can lead to premature births, low birth weight, and developmental delays and other serious complications. The impact transcends simple economic hardship, reaching into the core of health equity and social justice.

Interviewer: Dr. Sharma, thank you for sharing your expertise and insights on this vital issue. Your valuable insights highlight the urgent need for collective action to address these systemic disparities and ensure equitable access to maternity care for all.

Closing: The racial and ethnic disparities in maternity care spending are a critical health equity issue demanding an immediate and concerted response. We urge readers to share this interview and engage in the comments below with their thoughts, experiences, and suggestions for potential solutions.Let’s collectively work towards a future where every mother receives the high-quality, affordable maternity care she deserves, regardless of race or ethnicity.