Editor’s Note: Civil Beat is examining why life in the islands is so expensive in an ongoing series, Living Hawaii. We are looking at what’s behind high prices here and discussing ways to bring them down.

Imagine this scenario: You live in New Jersey, have no health insurance, are pregnant and intend to have the baby. You know it is going to cost you big bucks in the most expensive state for childbirth. So, what do you do?

You could give birth at the local hospital and hope there are no expensive complications. But about one childbirth in three in the U.S. ends up being via expensive cesarean section. You could get a midwife, but in some cases they end up directing expectant mothers toward the surgery room anyway, meaning that you could end up paying for both the midwife and the surgery. In either event, you might — like some other people — end up spending months or years paying off the birth of your adorable baby.

Or you could, at least theoretically, engage in a little “birth tourism” by flying to Hawaii. (Theoretically, because you would have to find an airline that doesn’t prevent all extremely pregnant women from flying.)

It may seem counterintuitive, but an expectant couple from New Jersey could fly first-class to the islands, stay for four nights in an oceanfront room at the Halekulani, have the baby at Queen’s Medical Center and still spend a few thousand dollars less than a hospital in their home state would charge just to deliver the child.

A priceless newborn.

Courtesy of Bridget Coila via Flickr

The average amount that hospitals in New Jersey charged for uncomplicated vaginal births in 2010 was $19,045, according to data compiled by the nonprofit Childbirth Connection. In Hawaii, it was $7,864. Birth aside, that leaves $11,181 for travel, pre-birth relaxation and post-birth recovery in the islands.

The numbers reflect what hospitals charged — not necessarily what new parents paid out of pocket. Deliveries are often covered by health insurance, and in Hawaii the vast majority of people are covered: about 93 percent of the population, according to Census data.

A typical uncomplicated vaginal delivery in a Hawaii hospital cost about $7,900 in 2010, the most recent year for which comprehensive national data is available. That was nearly 30 percent less than the going rate on the mainland.

Hospitals in the U.S. charged nearly $10,200 on average in 2010 for uncomplicated vaginal deliveries, according to data compiled by the nonprofit Childbirth Connection. 

(2010 data compiled by Childbirth Connection)

That’s excluding the amount hospitals charge for standard procedures once the baby is born: circumcisions, vaccinations and the like, which often end up costing several thousand dollars.

Hospitals in Hawaii charged about $12,700 on average for a normal delivery and hospital care for a newborn in 2012, and roughly $17,900 on average for a baby delivered by c-section, a Civil Beat analysis of rough data from the U.S. Department of Health and Human Services’ Healthcare Cost and Utilization Project reveals. The U.S. averages, on the other hand, were about $15,000 and $22,600, respectively. In New Jersey the costs were $31,572 and $41,699.

When Civil Beat brought up the relatively low price of giving birth in Hawaii to an array of hospital representatives, they said they were unaware of the discrepancy and were unable to explain why. The average hospital stay for a new mother in Hawaii — 2.1 days — is the same as the national average, suggesting that Hawaii mothers are simply being charged less for the same services they would get on the mainland.

Generally speaking, hospital care across the board appears to be slightly less expensive in Hawaii than the national average. A joint replacement, for example, cost $38,475 in Hawaii in 2012; nationally the charges averaged $52,642.

Some doctors point to the high percentage of people covered by insurance in Hawaii, which could help limit inflation. Hospitals tend to inflate prices when they’re dealing with a larger population of patients who lack insurance. Largely thanks to mandatory employer-sponsored health insurance, Hawaii has the third highest percentage of insured people in the country. Massachusetts has the highest.

A look at Massachusetts’ data reveals that hospital charges are also relatively inexpensive there. For example, Massachusetts hospitals charged $34,484 on average for joint replacements last year. Meanwhile, they charged $14,163 on average for the normal birth and hospital care of a newborn and $18,384 for a cesarean.

A preliminary review of hospitals in Hawaii suggests that most insured parents end up paying just a few thousand dollars out of pocket. At Queen’s Medical Center, for example, insurance reimbursements for deliveries — which generally cost between $7,000 and $14,000 — typically range from $5,000 to $11,000, according to hospital spokesman Cedric Yamanaka.

Still, the charges and procedures that insurance covers can vary greatly, as does access to hospital care. Molokai and Lanai don’t even have any obstetricians on island. And even in a state where childbirth is relatively inexpensive, many parents face unexpected costs from their time in the delivery room.

Lisa Kimura, executive director of the Healthy Mothers Healthy Babies Hawaii coalition, was stunned when she saw what Kapiolani Medical Center charged for the delivery of her first child, who’s now 7. Kimura had to undergo an emergency c-section with that child, a procedure that wound up costing $30,000 — 10 times what it cost to give birth to her 2-year-old son, who was delivered naturally without any interventions in the same hospital. Kimura, who’s now pregnant with her third, got involved with the organization she now works for after having her first child.

“I was shocked at how expensive it was,” said Kimura, whose employer-sponsored  HMSA insurance covered most of the cost. “I was equally shocked at how much (the bills) varied.”

Buy Buy Baby

While most expectant parents in Hawaii might take comfort in knowing that childbirth runs relatively cheap in the islands — at least compared to the rest of the U.S. — the subsequent cost of bringing up a child in the least-affordable state quickly offsets the benefits of the islands’ fairly affordable births.

Hawaii, for example, is one of the most expensive states for infant care: $12,500 a year on average. And if parents choose to enroll their kid in private school, as so many do, add on another $8,900 or so annually. Never mind other expenses such as food, clothing and transportation.

And of course, the actual delivery procedure makes up just a portion of what it costs to have a baby. There are childbirth classes (which run from $50 to $200), prenatal care ($2,000) and, of course, supplies.

Amber Richardson, who gave birth to her daughter about nine months ago, said she started saving the minute she found out she was pregnant to ensure she could afford the hospital costs and stay afloat during her maternity leave. The research and planning she did during her pregnancy helped her save money, but some expenses came unexpectedly.

“I’m a planner so I definitely had my lists, but certain things just didn’t work,” she said. “And I’m a new mom, so I was really flying by the seat of my pants.”

For example, while Richardson intended to breastfeed, post-partum depression affected her milk supply, forcing her to buy formula.

“It has definitely been worth the money, but I don’t know how we would ever afford to have a second child,” said Richardson, a program director at a local nonprofit. Her husband is a firefighter.

People in Hawaii pay more for goods and services than residents of any other state, and the baby expenses that parents pay outside of the delivery room can really add up.

Aside from big-box stores such as Target and Walmart, few stores in Hawaii sell baby products. Many parents interviewed by Civil Beat said they buy most of their stuff from online companies — namely Amazon — because it’s cheaper.

Tammy Karstens, for example, said she buys virtually all her baby products through the mail-order website. Karstens recently moved to Hawaii from the mainland with her three children, including an infant, and estimated that such supplies generally cost 15 percent more here than they do elsewhere.

Lana Crabbe, an expectant mother, said she too purchases everything off of Amazon because it’s less of a hassle and much cheaper, particularly because her “Prime” membership gets her free shipping.

“My cousin just had twins, and she said that’s one of the golden things I needed to do,” Crabbe said.

Most online stores, however, aren’t as convenient and charge high rates to ship to Hawaii; yes, the “paradise tax.” For example, a $100 purchase from Buy Buy Baby, a baby-store subsidiary of Bed, Bath and Beyond, costs nearly twice as much to ship to Hawaii as it does to a state on the mainland.

Civil Beat compared the prices of a selection of baby products at the Honolulu Target branch with the prices listed online. A few products are sold for the same price, but most of them are more expensive here — generally between 5 percent and 20 percent more expensive.

A sample basket of products purchased for $839.47 at the Target in Hawaii, for example, would go for $774.21 on the mainland — a difference of $65.26. Those savings could buy two extra packs of 148-count Pampers diapers. 

The cost of having a baby, of course, only grows with time.

But there are ways to save, starting with the delivery, as suggested above. Non-hospital births — at birthing centers or with the help of midwives in a home setting, for example — are always an option, often costing just a few thousand dollars. Future parents without health insurance can also negotiate with hospitals to seek discounted rates on the delivery.

Meanwhile, parents can cut costs by borrowing or renting baby supplies instead of buying them, Kimura said. Parents can also use cloth diapers and wipes to save money. One organization, Share the Love, even provides free cloth diapers to low-income families for up to three years, saving families roughly $60 a month. 

Many parents also buy used baby clothes and products on sites such as Craigslist and Facebook or consignment stores like Caterkids and Keiki2Keiki.

Richardson, whose daughter is now nearly 9 months old, bought nearly all of her baby furniture off of Craigslist. She also found a fellow mother on the classifieds site whose daughter is a couple months older; the mother regularly sells her used clothes for $10 a bag. 

Parents like Richardson say it’s easy to avoid the Hawaii markups by being resourceful and taking advantage of all the baby products constantly being recycled. After all, approximately 19,000 babies are born in Hawaii each year.

They may come fairly cheap, but unless parents are very resourceful, they don’t stay that way.