Along with Kate Middleton’s perfect hair and seemingly effortless appearance in heels just hours after Britain’s newest prince was born, here’s another thing to be envious of: The Royal Birth—in a private hospital in one of the world’s most expensive cities—still probably cost less than an average delivery in the United States.
The Lindo Wing of London’s St. Mary’s Hospital is “a luxurious private maternity ward in London that has often been used by the royals and which boasts a comprehensive wine list for celebrating parents,” the Economist reported Monday. In 2015, according to the website’s analysis, the Lindo Wing charged the equivalent of $8,900 for 24 hours in a deluxe room and a non-Caesarean delivery.
By comparison, a survey by the International Federation of Health Plans found that, in the same year, the average fee for a similar delivery in the United States was $10,808. That’s the highest price, by far, included on the Economist's striking graph comparing the average price of a normal-birth, private-sector delivery in 11 different countries. (And some estimates are even higher.)
After the United States and the Royal-favorite Lindo Wing, Switzerland came in third for childbirth costs, followed by Australia, France, Chile, and the Netherlands. The average cost of delivering a baby in Britain—a non-Royal, that is—came in eighth, at less than $3,000.
So what exactly is going on that makes having a baby here so expensive? Ashish Jha, MD, director of the Harvard Global Health Institute and professor of global health at Harvard T. H. Chan School of Public Health, says there are a few reasons for the discrepancy.
For starters, doctors and nurses are paid a lot more in the United States than in other developed countries. “Everybody in the health care system is drawing higher salaries—in some cases 50 to 100% more than in the U.K.—and that draws the prices of those services up,” Dr. Jha tells Health. In a study published earlier this year in JAMA, Dr. Jha and his coauthors showed that the average 2016 salary for a general practice physician in the United States was $218,173, while in other countries the range was $86,607 to $154,126.
In addition, new moms tend to stay in the hospital longer in the United States than in European countries. “We always talk about drive-by deliveries, how it seems like women are kicked out of the hospital after a day or two, and how 30 years ago they’d stay for a whole week,” he says. But in Britain, it’s common for women to go home the morning after giving birth, or sometimes even the same day.
That may sound harsh, but there’s also an upside. “Instead of having women spend a lot of time in the hospital, they’ll have two or three midwife visits over the next few days at home,” says Dr. Jha. “They really pack in these outpatient services that are cheaper, and a lot of women prefer to be at home anyway.”
The fact that American women are more likely to be overweight may also add to health care costs, says Dr. Jha. But he also points out that women in Europe are more likely to smoke—so in some ways, American women may have fewer health problems and less potential for birth complications.
It’s also been suggested that American doctors perform more C-sections or take more precautions with deliveries, which can drive costs up. But the Economist's chart makes it clear that even when comparing apples to apples, the United States comes out on top—and not in a good way.
It’s not just childbirth that costs more in America, either. “That graph is somewhat consistent with almost anything in health care,” says Dr. Jha. “If you looked at MRIs or if you looked at knee surgery, you’d get essentially the same difference in numbers.” His research shows that spending related to pharmaceuticals and administrative costs are higher in the United States, as well.
And that's not even the most frustrating thing about this topic. The Economist also points out that the true cost of having a baby—including care given before and after a pregnancy—rises to roughly $30,000. While insurance often covers most of that cost, parents still have to cover about $3,000 themselves. “In many European countries,” it’s noted, “free maternity care is available.” Money points out, for example, that Britain's National Health Service provides free maternity care to residents who give birth in the public hospital system.
So what are expectant parents in the United States supposed to do about this burden? Having a job that offers health insurance can certainly help; so can buying your own insurance through the Affordable Care Act. But either way, there’s a good chance you’ll have a high-deductible plan that requires you to pay a large sum of your childbirth costs out-of-pocket.
Having a health savings account or HSA (an option with many insurance plans) can help you gradually save for big events like this. “Especially if you’re in a high-deductible plan, these accounts can be critical for putting money away and absorbing the shock of having a baby,” says Dr. Jha.
It can also help to shop around for your care. “The nice thing about pregnancy is that you have some time to figure out where you’re going to deliver,” says Dr. Jha. “Call hospitals and ask about the costs for these services, and make sure you look at all your options.”
He admits, however, that getting information about hospital pricing can be difficult for patients—and that’s one reason change is needed throughout the entire industry. “There are states like Massachusetts that have adopted price-transparency laws, but as a nation we’re just not where we need to be,” he says. “I’d love to see the federal government really push for price transparency more aggressively, so that consumers get a real chance to make smart, informed decisions.”
In addition, he says, there’s growing consensus among providers that American health care costs need to come down. “This is a reminder that our price problem is really out of control,” he says. “Nobody wants to see their own salaries cut, but the truth is, we’ve got to find a mechanism to lower these prices.”