Geographic and Socioeconomic Variability in Commercially Negotiated Pricing for Hip and Knee Arthroplasty

Total hip and knee arthroplasty (THA/TKA) are among the most common and costly orthopedic procedures in the United States. While hospital-level pricing drivers are known, the influence of community socioeconomic and geographic factors remains unclear. This study aimed to evaluate both hospital-level and community-level predictors of THA/TKA pricing.

A retrospective cross-sectional analysis used commercially negotiated THA/TKA inpatient hospital prices (Medicare Severity-diagnosis-related group 470) from 2,286 US hospitals encompassing 5,946 prices across 5 major commercial payers (Turquoise Health, March 2024). Prices are defined as claims costs reimbursed by payers, excluding surgeon, anesthesia, and outpatient fees. Hospital price data were linked to county-level socioeconomic, clinical need (e.g., arthritis prevalence), and hospital structural characteristics (e.g., bed count). Multivariate linear regression assessed associations between hospital/community factors and log-transformed prices.

Negotiated THA/TKA prices were significantly higher in rural than urban counties. Multivariate analysis found that higher prices were associated with larger hospital bed count (+5.20% per standard deviation [SD], p < 0.001), higher Case Mix Index (+5.34% per SD, p = 0.002), and counties with minority population populations (+3.19% per SD, p = 0.001) and uninsured rates (+2.91% per SD, p = 0.019). By contrast, higher arthritis prevalence (-3.13% per SD, p < 0.001) and Social Deprivation Index scores (-7.23% per SD, p < 0.001) were associated with lower prices, which suggests that high-need populations face lower hospital reimbursement or reflect price adjustments in response to local economic capacity.

Commercially negotiated THA/TKA prices are influenced by both hospital structural factors and the demographics of the surrounding community. Higher prices in areas with larger minority populations and more uninsured residents may reflect systemic drivers of geographic and demographic disparities in healthcare pricing.

Level III. See Instructions for Authors for a complete description of levels of evidence.