Price and Prejudice: Reimbursement of Surgical Care on Male Versus Female Anatomies

Background: Gender bias is a pervasive issue in health care, contributing to poorer health outcomes for women compared with men. In the United States, studies have shown a slowly improving, but persistent, disparity exists for gender-specific procedures' relative value units (RVUs). This study aims to build on existing literature and conduct a large-scale analysis examining comparable gender-specific surgical procedures to determine whether there remains a disparity in RVUs/reimbursements for care provided to female patients. Methods: Using 110 CPT codes, we compared work RVU and reimbursement rates for facility and nonfacility procedures within the 2023 dataset for anatomically similar gender-specific procedures, verified by a group of gynecologists and urologists. We analyzed the procedures over a 20-year period with RVUs from 2003 to 2023 to determine how the difference between the gender-specific procedures was changing over time. We also used the same design and 22 current procedural terminology (CPT) codes as Goff (1997) and Benoit (2015) to compare RVUs between 1997, 2015, and 2023. Results: For the 55 gender-specific procedures, 41 (75%) had lower RVUs for procedures on female patients in 2023. RVUs for procedures on male patients were 30% higher on average. For facility reimbursement, 35 (64%) were higher for procedures on male patients-with a 25.6% higher reimbursement on average, correlating to an average reimbursement of $75.73 more for male procedures. For nonfacility reimbursements, male procedures were reimbursed 20% higher on average. Between 2003 and 2023, there were no statistically significant improvements in the reimbursement disparities for male versus female procedures, with male procedures consistently having an average RVU 31-34% higher. The disparity narrowed minimally between 1997, 2015, and 2023. Conclusion: There remain significant disparities between gender-specific procedures, with lower RVUs/reimbursements for procedures on female patients and minimal change over the past three decades. Addressing these disparities is crucial for achieving gender equity in health care and ensuring equally valued medical services.