Governing the OR: How Do Political and Regulatory Landscapes Influence Pediatric Urology Surgery Costs?

To examine potential associations between state-level policy factors and hospital-rate prices for pediatric urology procedures.

Hospital-specific pricing data for specific pediatric urology procedures were obtained from the Turquoise Health Database in 2025. Hospital rate (payer-specific facility fee after discounts or negotiations excluding professional fees) for various pediatric urology procedures was linked to state-level policy variables for each state including political lean, Medicaid expansion, certificate of need (CON) laws. Multivariable regression assessed associations between prices and predictor variables.

56 US pediatric hospitals reported prices. Median procedure price was $5,905. No significant pricing differences were found between Democratic versus Republican leaning states across most procedures, except for hydrocelectomy (lower in Republican-leaning states by -$1,530; p < 0.05). Medicaid expansion and CON status showed no significant association with pricing. However, states leaning either Democrat or Republican had significantly lower negotiated rates (47% and 46%) than centrist states when adjusting for relevant factors (p=0.008, p<0.001).

Although variation exists for US pediatric urology procedure pricing, it appears largely unrelated to state-level policy factors, which contrasts with findings in other surgical subspecialties. This may challenge assumptions that state-level policy reforms significantly address cost variation, underscoring the need for further research into hospital-level drivers of pricing.