Interfacility Competition and Its Impact on Cost of Carpal Tunnel Release

Carpal tunnel release (CTR) is the most common hand surgery procedure, but little is known about how health care market characteristics influence cost. The objective of this study was to understand the association of health care market competition and facility availability on out-of-pocket and total insurer payments for patients undergoing CTR.

This retrospective cross-sectional study used a national sample of private insurance claims from 2015 to 2020. Adults who had CTR were included, whereas acute or inpatient CTRs or those lacking geographic information were excluded. Linear regression was applied to investigate the impact of the health care market competition and facility availability (ambulatory surgery center [ASC], hospital outpatient department [HOPD], outpatient clinic) on the out-of-pocket expenses and total insurer payment. Market competition was measured using the Herfindahl-Hirschman Index.

Of 119,828 patients, 76% underwent open CTR. The most competitive hospital markets were HOPDs and ASCs, respectively. As HOPD competition decreased, out-of-pocket expenses and total insurer payment decreased significantly. As ASC competition decreased, only total insurer payments decreased significantly. CTRs performed in outpatient clinics increased slightly over time. However, HOPDs remained the most common location until 2020 when their popularity was similar to ASCs. Finally, out-of-pocket expenses increased significantly whereas total insurer payments did not change significantly throughout the study period.

This study found that decreased health care market competition was not associated with increased CTR costs, suggesting that costs are complex and multifactorial. To reduce health care costs, this study supports the movement of CTRs to clinic and ASCs.