The chart is really misleading. It's labeled: "Here are the average 2015 prices for a vaginal birth, not including costs for care before and after giving birth" but for the UK it lists the price of the royal baby's fancy birth. A normal birth in the UK is free!
My daughter was born by C-section in the UK. Mum and baby stayed in the hospital for a few days to recover from the C-section. This would have been completely free but they would have had to share a room with 3 other mums and newborns. That's not so nice so we opted to pay for a private room.
The cost for a private room in a hospital in the UK was the equivalent of $100 per night! In a HOSPITAL! Coming from the US that blew my mind.
My daughter was born premature. Mum was in hospital for a week prior and post birth (in her own room). I was given a room for the week next to the hospital. Then when daughter was born she was in hospital for four months of intensive care - in conversation with a doctor he remarked that the cost to the NHS for this would have been about £125k. Coming close to release time we were given a room in the ward so we could be with our baby 24 hours.
Cost to us for the whole thing - £0.
We were even given a pass so we could get free parking throughout.
The one downside to the whole thing, when it came to crunch time there was no space in the nearest neonatal ward, so we had to be rushed in an ambulance the the nearest one that did have space. About 200 miles away, so we weren't able to go home for a couple of months until baby was stable enough to be transferred closer. It was tough, but I will be forever grateful to the NHS for the amazing effort that everyone involved happily contributed.
Here in Scotland when my son was born, he needed to stay in hospital for 10 days for what turned out to be benign myclonic jerks in his sleep.
The midwives gave my wife her own room and even set up a camp-bed for me. They gave me tea and toast in the morning joking that they weren't sure they should do, but there was enough to spare.
We didn't need to pay anything and both being on paid parental leave took any financial pressure off so we were able to concentrate on the baby.
Similar experience here - one thing I noticed, the yogurt pot that came with every single meal had a mis-matched lid and side label.
They were literally the 'seconds' rejected from the consumer market. No pudding for you if you happen to be allergic to one of the unknown possible flavours...!
Cost out of pocket and actual costs aren’t the same thing.
The overall health care is likely cheaper but you do pay for it your entire adult life.
So while they charged you $100 during birth (btw that’s extremely cheap a private room in a central London hospital without insurance copay is a few £100’s a night) you pay for that room from your first paycheck to the last.
Yes we do, and that's fantastic, because that's also paying for my sister's cancer treatment, my Mum's thyroid medication, the drugs Dad had to clear up a fungal infection in his toenails, the surgery my friend had to reassemble his ankle after he smashed it up slipping down a grassy slope...
Don’t know without my ~£3000 a year insurance I’ll have better luck with pubmed than with the NHS unless I’m bleeding out of 2 or more holes with one of them not being native to my body.
The only problem I have with it is that unlike say Germany I have no option to go completely private. I
National Insurance represents less than 20% of NHS funding. But I guess you're right if you consider general taxation as contributing into the HM Treasury fund.
I'd expect anything dominated by skilled labor cost to be about twice as expensive in the US than in the UK... I mean, I don't know if doctor pay scales like SWE pay, but as far as I can tell, London pays software engineer types half of the US national average (which is rather less than what silicon valley pays.)
(of course, I think we'd be better off in the states if we expanded medicare to everyone, giving everyone a baseline level of insurance... but I'd also expect it to be more expensive here than in the UK, just 'cause the payscales here are... pretty different.)
So basically the glorious NHS is possible because doctors aren’t paid a living wage? I seriously doubt one can afford to buy a house with that kind of income.
A SWE in London makes like the equivalent of like USD$65K or something. I think that wages are just much lower across the board for skilled labor once you leave the major cities in the USA.
(I'm curious how this shakes out on the low end, and if it's just that in the USA, skilled labor captures more of the total labor compensation than in the UK, 'cause I didn't think our per-capita gdp was that far off. In silicon valley, unskilled labor pays around USD$15/hr. the rest of the country it's closer to USD$8/hr. There are a lot of people who try to live on that. What would the equivalent be in London?)
And taxes are much higher, too, and goods are significantly more expensive as well.
We’re talking about skilled, professional labor specifically, and boy, professionals are getting screwed over there. Here in the US you can afford a decent lifestyle on a doctor or SWE salary even if your spouse doesn’t work. I don’t know what folks in eg London do. Shit’s crazy expensive in London.
But how are things different for the poor? The per capita gdp isn't as different as the salaries for skilled labor, so I wonder if the poor make more over there or if there is something I am missing.
Huh. In San Francisco, USD$30K/year puts you above the 20th percentile, below the 40th percentile for a household - I mean, I guess, sure, that seems poor but it's not uncommon. two people making USD$30K/yr would be getting close to the median.
(median household income in SF is USD$75K/yr. I don't see how you could live in SF on that money without serious rent control or owning your place, but fact is it's the median household income. Come to think of it, I know a fair number of people in that situation; making under $75K/yr and living in a rent-controlled place.)
Interestingly, median household income in london, as far as I can tell, is GBP40.000 which is like USD$55K - which isn't nearly as large a difference as I see in, say, SWE wages.
But you also do that in the US, you just don't benefit from it until you are 65.
The US does have socialised medicine: Medicare, and it costs as much as the health care systems of other countries, only it takes care of only a small part of the population, whereas in other countries it takes care of everybody.
How is the chart misleading when it is the supporting evidence in an article titled “Kate Middleton’s ‘luxury’ birth cost less than the average U.S. birth”?
Same story with both of my children. C-section both times so my partner stayed in hospital for a few days. With the first one we opted to pay for a single room for a couple of nights, but didn't bother the second time. Total cost for both births was less than £200, and that was just for the single room.
The idea that people have to pay huge amounts of money for a basic human need like safe childbirth is very troubling.
Don't know whether to laugh or cry that 20 pounds is considered a fortune for parking and gas. Depending on the area, you could easily blow through that in an afternoon over here. T_T
Current parking charges at Bolton are £4 for 24 hours (they were lower in 2012). 4 trips about 15 mile round trip was about £2 each at that time.
There's a lot of complaining about the fact it costs as much as a cup of coffee to go and visit people in hospital. Those with chronic conditions tend to get free parking (at least where I live now in Cheshire).
Considering how hugely complex and difficult a child birth is, and considering that there are professional doctors and trained nurses available for free, the complaint about the cost of a private room because what is given for free was 'not so nice', is, to my mind, seriously taking things for granted.
Yes, the chart is misleading, giving birth in Spain is free as well, you may just pay the cost of the parking and whatever you take from the vending machine while you're waiting. I believe the chart refers to private hospital births where you get to have a room for yourself, etc.
The point I rarely see discussed in these ongoing debates about the best way to pay for healthcare is the benefit of knowing what you have to pay.
As I understand it in the US even with health insurance there is likely to be an additional payment required by the patient for treatment, and the cost of that payment is generally unknown upfront.
With the NHS is the UK I can be pretty confident that no matter what medication my doctor prescribes that when I collect it from the pharmacy it will cost me exactly £8.60
I can also be confident that when I go for an appointment to see my GP that it will cost me nothing. This doesn't mean that is is free, as my National Insurance contributions are substantial, but that I know that I don't bear any financial risk from going to see a doctor.
I can't imagine what it would be like to have to worry about whether going to see a doctor about this mole that's changed a bit might land me with an unknown bill. Or to worry that my daughters peanut allergy could see me paying hundreds of dollars when her adrenaline pens expires.
> This doesn't mean that is is free, as my National Insurance contributions are substantial, but that I know that I don't bear any financial risk from going to see a doctor.
In fact, it's more important than that. Because you pay NI upfront, it relieves the feeling of burden that you might otherwise feel towards the NHS, which actually makes you more willing to go to the doctor. This means you're more likely to catch minor things before they become major problems (further reducing NHS costs).
Exactly.
It's bad enough to be worried that you might have skin cancer, then to worry so much about the cost that you don't go see the doctor can only compound the issue.
I would guess (and don't know) that if you had super amazing insurance then maybe it covers all these unexpected extras. But for those that do not have that level of cover the decision must go something like:
I'm worried that this mole looks bad,
if I go and see a doctor then I might get a nasty bill,
but if I don't go and see a doctor then it might get worse and when it does I'll have no choice but to go,
oh and the cost of the treatment could bankrupt my family
Yes! I completely agree. Actually in my experience it's even worse - not only do you not know how much the bill will be, you never know when you've received the last bill! First you get a bill from the hospital, but a week later you get a separate bill from the anesthesiologist, then some days later another for the ultrasound technician, then some days later another for the ambulance, etc...
This was for the hospital car parking for 3 days to visit my wife while she recovered in maternity ward in a private room.
Everything else was free, from the first scan, through to delivery, and the standard of care was good.
Didn't need specialists, but if we did that would have been free too.
We have private health insurance as well (NZ$300/month to cover the family), but in public health care is good enough, private is for when you want to get treated faster for less critical things.
And that car park is a disaster. I’m guessing you refer to Auckland Hospital. If you are, wait until midnight and the gates open and it becomes free. You can tell when it’s going to be free soon as half the cars have people sitting in them.
Also worth pointing out that in the UK, we were offered three choices of births. Home, water or hospital. We started off in the birthing pools until mum decided she wanted the epidural after all. I thought all three of options were quite luxurious and service by the midwives was second to none!
If I think about our decision making process for a car-seat (oh god, let's go for the best - just in case), I am glad that no-one has put a monetary value on giving birth.
I'd never thought of it like that, but we did exactly the same thing with the child seat. I daren't imagine what would happen to the state of neonatal care if it were privatised here.
Here's the price list for the private hospital they used.
Note things like "If your baby requires transitional or specialist care, this is free if they are entitled to NHS care and is chargeable if they are not." -- British (and EU etc) patients can pay for the luxury private room and so on, but if they unfortunately need significant extra care, public healthcare will cover that.
In "normal" cases, roughly, 500 USD or less if you have insurance.
But it's really awfully complicated -- often the baby gets a separate bill too to muddle the waters. The ACA ("Obamacare") set a cap on in-network yearly out of pocket payments on family plans which, if memory serves, was around 11k in 2017. A complicated birth can hit this! Consider the costs of NICU, for example. (Oh and if an NICU nurse reads this: thank you, thank you, thank you for the life of my niece.)
Each person tends to have a max yearly limit. By billing the baby separately, the yearly max for the mom and the baby can be hit (or the family max). This is especially important as the mom may have already received a good amount of charges leading up to the birth.
The baby doesn't 'get a bill' in the sense that I think you are suggesting (based on this on your comments down thread.) The parents get a bill with line items listed for services provided for the baby.
The expectation is that the baby will be added to the insurance plan effective as of birth, so it's correct to bill services provided to the baby as... services provided to the baby.
Am European, can confirm. The idea that the first thing a kid gets in this world is a bill for healthcare services is amusing in a chilly sort of way. I mean, it's not like the poor kid had a choice in the matter of whether he's born or not.
What happens if the parents can't afford it? Does he, like, get to go back in until the parents pay? If he had an ailment, and it got cured, do they give it back to him? Do they put him in suspended animation :-)?
It's the same in Europe though. The hospital will send a bill to the insurance company (usually there is one default and you can switch your children to another any time) in the name of the child.
Of course there's a bill being handed out someplace, since hospitals pay medics in money not booze. Yes. The insurance operator (public or private) gets the bill.
It may not look like much to those of us who hang out on HN, but if you have a normal job, serving drinks or selling stuff in a brick and mortar shop or whatever, there's a world of difference in details like who gets the bill, what you need in order to get insurance and so on.
Yes, the paperwork is hidden from you, but its present, the hospital still needs a way to obtain funds from NHS, see: https://en.m.wikipedia.org/wiki/Healthcare_in_England - "The National Health Service (NHS) is free at the point of use for the patient though there are charges associated with eye tests, dental care, prescriptions, and many aspects of personal care."
Please note that you basically listed two exceptions (plus other Nordic companies), most of EU countries have a system that combines private insurance companies with a combination of public, semi-public and completely private health providers.
The thing is, "billing a child" is not really the proper description.
What's actually happening is that:
1. A claim is submitted to the insurer, naming the baby as recipient of the claimed services. The parents are responsible for ensuring the baby is added to the policy within a reasonable amount of time.
2. If the insurer declines to pay some portion the hospital is entitled to collect, the hospital will send a bill to the parents, and the parents will be responsible for it, though the bill will be for services provided to the baby.
I'm European and this is exactly how it works here. The child is billed, you just don't know it because it's handled behind the scenes.
And no, braces and glasses are not free. Again, the child is billed, and the bill is sent to its health insurance company; also, the requirement is not just most basic type, it also needs to have a medical reason, so braces just because you want to look good aren't free, you need to contribute (I had to pay around 25,000 CZK for example, equivalent of one average monthly wage).
It's for the pediatrician's services. Remember, Babies generally stay in the hospital for 48-72 hours after birth, and they get visited and tested by doctors and nurses during that time, not to mention vaccines, care in the nursery, etc... it actually makes a lot of sense that the baby be considered the patient.
You are missing the reason I'm surprised and amused - and I'm really not sure how much clearer I can be here. It's not that healthcare services themselves are charged. The baby is billed. Like a letter with the little transparent window with the name and address of a couple-of-days old child is sent.
If you cannot see why that seems weird, shocking, amusing ... whatever then I don't know what else I can tell you.
The first letter you got after a birth in Germany used to read something like this and is addressed to the newborn (hopefully they have changed it by now):
Regarding: Assignment of the Tax ID according to § 139b of the tax code
Dear <name of the newborn>,
the Federal Central Tax Office has assigned you the Tax ID <number>. It is used for taxation purposes and valid your whole life. Please keep this letter even if you are currently not paying any taxes. Always mention your Tax ID when communicating with financial authorities. Please also note the information on the back.
The article suggests the end payment is around $3,000 after insurance, which is still more than the ~US$2,000 + 500/night you’d pay for a non-resident birth where I live. I’d be free if you were a resident, unless you want a premium room with a bed for your partner to stay in when it would be ~US$300/night.
This is completely anecdotal of course but... my insurance covered all but $700 of the birth. The total cost was over $15k.
What it did not pay full for was ultrasounds. Which aren't technical part of the birth. They only paid full for the first one and we needed 5, which was about $300 each out of pocket for me.
But I hear my experience is not typical. Usually out of pocket costs (even with insurance) are much higher in the US.
Our out-of-pocket has been $175 including delivery and postpartum care. We’ve needed to stay 48 hours in recovery for medical reasons at no additional cost (cesarean recovery allows 96 hours). The article conflates per-night and per-visit costs.
Usa here, with decent health insurance at the time.
C-section birth, plus 4 day stay at the hospital (Max included allowed by insurance). Total billed by the hospital was something crazy around 11-16k? I forget actual number. It was a decent stay/food but nothing crazy over the top about it.
After all said and done we paid $1100 for our hospital stay. I was happy it was this "cheap".
P.s. oh yes, also hospital car parking -I think I was there total for 5 days so $12x5=$60.
Sales tax in the UK is 20%. A gallon of gas is >$7. Salaries are miniscule compared to the US. SF/NYC real estate is a bargain compared to London. And the NHS, well hmm...
In Russia giving birth is free, as is whatever-long stay is hospital (in shared room). Of course, you can have private room, where father, mother and child can stay for as little as 100$ a night.
Actually, state pays mother about 7000$ for second child in addition to all normal allowances and benefits.
In this case it's a UK private hospital not funded by the NHS so the comparison is valid. The article compares one of the most expensive private hospital of the UK to the cost of an average US hospital. Also the US spends more in public taxes for healthcare than the UK so I don't see your point.
Should highlight that many private hospitals are attached or "next door" to NHS hospitals. With surgical "complications" (post-infection, mid-op crash, etc), many of these private hospitals will discharge their patients to the NHS hospital for care.
How? Because they can. It keeps costs down and the NHS can't [0] refuse to treat somebody, even if they're coming from a private surgical ward.
I'm not saying that's what's happening here, but this is one reason why private elective care is so cheap in the UK. The other being that they have to compete with £0.
It's actually a UK NHS hospital which operates a private maternity wing on the side. The email address in the brochure is even @nhs.net. They're probably relying on staff and resources from the NHS side to handle more difficult births too.
Private companies who provide services to the NHS also get @nhs.net email addresses. It's a secure email system so that patient and other confidential data can be exchanged between providers without it going out onto random internet mail servers.
An @nhs.net email doesn't mean "this person/organisation is a part of the NHS", it means they provide services to the NHS and need to deal with patient data.
As it says on the hospital's website, "difficult" births will be free to those eligible (British, EU etc) but will be charged to others (presumably people like the wealthy Arab people in the brochure).
> This is not true, the US spends as much government money per capita on health care as the UK
Per capita spending seems like a misleading basis for comparison to me. US government healthcare schemes cover about 25% of the population, whereas in the UK the NHS covers essentially 100% of the population.
It's OK for taxes to pay for anything, you just have to remember that just because you don't swipe your credit card or get a bill it doesn't mean that something is "free".
This is just disingenuous. And perhaps the wrong way to think about it.
Sure, it's not 'free'. But when you pay taxes, everyone doesn't pay equal amounts. Those who are able to earn more money, pay more taxes. Those who can't pay less. But no one is left to fend for themselves. Even the poor can get treatment. We're also not paying anything like the insane prices you pay in America.
I would like to differ and make the claim that most of it actually is indeed "free", since we are all living very comfortably off a huge inheritance and network effects:
A midwife delivered my kid in the bedroom for two orders of magnitude less money.
Not to mention, thousands of years of doing it without even a midwife was somehow good enough to keep the species alive long enough for hospitals to be invented so people could think having a baby requires one.
EDIT: Sorry to distract you with that last bit. A midwife, you're paying for a license and a sterile pair of scissors. It works fine. The idea that you need a huge medical apparatus and to pay $10 grand for it, to do something humans evolved to do, is pretty FUDdish.
Home birth doesn't have to be unsafe as long as you have well-trained mid-people and easy access to a hospital in case of complications. An uncomplicated birth doesn't need a hospital, and most births in Netherland still happen at home. It works fine if your system is designed to allow it.
Although if birth-related mortality is rising while home births are dropping, doesn't that suggest there's something else going on? The relatively high age of Dutch mothers may also be a factor (I believe the average age at which women have their first child is around 30).
Having read a bit more about the issue, it appears the jury is still out.
>Although if birth-related mortality is rising while home births are dropping, doesn't that suggest there's something else going on?
Huh, where do you see mortality rising? The link refers to a decrease: "Historical data show that 7-day (28-day) mortality declined from 4.25 (5.35) deaths per 1,000 births in 1980–1985 to 2.42 (3.18) deaths in 2005-2009"
>Having read a bit more about the issue, it appears the jury is still out.
I don't know how you can think that. Every statistical comparison shows home births kill babies. Unfortunately, there are still people who claim otherwise, but none of them have data to support their claims.
That why it says "not to mention." It's an additional/supplemental point on top of the main one about my child's birth, which shows that at least that one home birth was safe. And cheap.
No, one wasn't safe. One was risky, but luckily happened to end all right. Just like driving drunk is unsafe even if you make it home in one piece. Safety is statistical, not anecdotal. Here are the statistics: http://www.skepticalob.com/2014/01/homebirth-midwives-reveal...
You utter prat. My sister is an NHS midwife and went through three years of highly technical university education for it. It's a skilled job and she's saved lives when things have gone wrong. Should we all go back to living in mud huts instead of professionally-built houses, too?
You seem to be making two contrary points: that midwives are trained and skilled, and that they're primitive and unprofessional like mud huts. This is consistent with, for example, someone's pretending to respect their sister's line of work because they're family. Pretty sure you're also afoul of the site guidelines by openly name-calling.
Interesting question, and I can't really answer it, not being American - "prat" basically means an idiot, but it's quite a useful word because it conveys a real sense of contempt (but often more for the opinion or act than the person responsible for it, in a weird way), and can easily be intensified as in this instance, without actually being vulgar. You can also use it as a verb, eg. "Stop pratting around on Hacker News and do some work!"
I also feel like it was 100% the correct word to use in this instance!
To be fair there was a far higher mortality rate up until relatively recently. (I wouldn't be surprised if the lack of sterile conditions did give the surviving kids immune system a good kick start though).
It works fine as long as there are not complications. Births are incredibly dangerous for the mother and the infant compared to almost anything else we do.
Research isn't great but it seems to show that home births are more risky than hospital births; that midwife led care is safer but only if there are both obstetricians available and strong multidisciplinary working.
Research isn't great but it seems to show that home births are more risky than hospital births
I wonder if home births can ever be safer/less risky than a hospital birth.
My wife had emergency surgery (not all cesareans) with each of my kids but even if you just take the first time when she was low/no-risk, she would most likely be dead if she'd chosen to give birth at home. Both me and her were also born by emergency caesarean, so I might be a bit biased in favour of hospitals here though ;-)
My daughter was born by C-section in the UK. Mum and baby stayed in the hospital for a few days to recover from the C-section. This would have been completely free but they would have had to share a room with 3 other mums and newborns. That's not so nice so we opted to pay for a private room.
The cost for a private room in a hospital in the UK was the equivalent of $100 per night! In a HOSPITAL! Coming from the US that blew my mind.