For all who have them, a vagina is a chronic health experience. As a result, the costs and accessibility of reproductive care are extremely important to understand. Over the course of a lifetime in the U.S., period products alone cost on average $6,360. If one doesn’t want to be pregnant, birth control adds up to $2,000 a year, with long-acting reversible contraceptives costing up to $1,300 without insurance. If one does want to be pregnant, the average childbirth cost is around $19,000 — not including pre-natal/post-natal care, emergency procedures, or any necessary hospital stays for parent or child/ren post-birth. The cost of caring for the reproductive system comes into play when patients, depending on their financial status, have to choose between “maintaining” versus “spot treating” their reproductive health. Doximity spoke to two ob/gyns treating patients at different ends of the socioeconomic spectrum about their experiences, and about how to bridge the gap in care.
Dr. Brianna Hickey, an ob/gyn resident in Minnesota, currently works at a city hospital providing care to Medicaid patients and those who are uninsured. She often sees patients coming in through the ED out of desperation or dire need. “Some patients come into the emergency room and find out that they're pregnant,” she said. “So we're helping with prenatal care and getting them established in the system. Sometimes patients come in with a pregnancy that has failed or other causes of heavy bleeding. A patient may even come in as a result of substance use disorder and then reveal a gynecologic issue so at times it begins with caring for one problem and then switching to care from a gynecologic standpoint.”
While low-income patients arriving to ob/gyn through the ER may only be able to afford to come in for present needs, high-income patients arriving to ob/gyn from other avenues can afford to plan for their reproductive future. Dr. Padmavati Garvey, a recently retired ob/gyn, provided care in both hospitals and private practice settings over the course of her career. Most recently, she worked at a private practice in upstate New York. Dr. Garvey noticed that, over the last few years, more younger women have been interested in freezing their eggs. “It is becoming more common for young women with the means to seek permanent methods of birth control, including having their tubes tied,” she said. But how much does a decision like such cost? Without insurance, egg freezing can cost from $10,000 to $20,000, which includes medication, doctor visits, and the actual surgical procedure to remove the eggs. It doesn’t, however, include the yearly storage fee for frozen eggs, which can be up to $800. In contrast, women requesting an IUD for contraception are significantly more likely to have an IUD placed when their out-of-pocket expense is less than $50.
Though they served different socioeconomic demographics, both physicians noted similar desires for care among their patients. Or, as Dr. Garvey said, “I’ve found that women from all walks of life have very similar reproductive issues.” Drs. Hickey and Garvey both have seen a majority of gynecologic issues tied to patients wanting to manage menstrual pain, heavy bleeding, pelvic pain, and vaginitis. Contraception and family planning were also especially popular among both demographics.
Indeed, health goals and concerns are often shared by patients from vastly different backgrounds; thus, clinicians should be aware of the costs of such care for their respective populations. Before the Affordable Care Act, one in three women in the U.S. (27 million total), were uninsured, and another 45 million delayed or avoided health care because of cost. By 2018, after the Affordable Care Act, an estimated 10.8 million women were still uninsured. Over the course of her career, Dr. Garvey found the high costs of reproductive care to be a barrier for the uninsured and low income: “The cost of insurance, the cost of medications, the cost of procedures, and people needing something and not being able to afford it, the copay is too high, or their deductible is too high.”
Another barrier that Dr. Hicks has acknowledged is language. Her patients are primarily immigrants and for many, English is not their first language. She shared, “I'm regularly using an interpreter phone probably for over 50% of my patients. It’s hard to have intimate conversations especially when their first language isn't English or they don’t speak English at all. Getting to interact with patients even through an interpreter is great because reaching them in their own language makes a huge difference in being able to connect with them.”
The pursuit of care, access to it, and the future of it looks completely different for patients who can afford it versus those who cannot. This is despite the fact that vaginas require lifelong care irrespective of income, and often incur unavoidable medical bills. According to Drs. Hickey and Garvey, patients desire care that addresses present concerns and incorporates their reproductive future. Everyone deserves to be able to pursue care and envision a healthy future compatible with their health goals. This kind of visionary medicine requires accountability and addressing the ways in which the health care system can do better so that it can be better for everyone. Period Law works with volunteer attorneys to end the tampon tax and collection of taxes on medically necessary products on a state and federal level. As of today, the organization has been successful in 18 states – an annual savings of over $120 million.
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