Experts Sound Alarm on Gender Gaps in Medical Reimbursement Rates and Their Impact on Women’s Health
A new study comparing male- and female-specific medical procedures found clear disparities in how they are reimbursed. Dr. Jocelyn Fitzgerald and Dr. Louise King, practicing gynecologic surgeons and contributors to the study, spoke with Hologic about what the findings mean for patients, innovation and the future of women’s health.
The study, titled “Price and Prejudice: Reimbursement of Surgical Care on Male Versus Female Anatomies,” looked at Medicare reimbursement rates for 55 equivalent procedures — for example, a vaginal biopsy for women compared with a penile biopsy for men. Medicare payments also heavily influence commercial insurance reimbursement rates.
The takeaways were striking: On average, procedures for men are reimbursed 30–50% more than those for women, despite being of equal or lower complexity. For urinary tract procedures the difference jumps to as high as 125%.
Reimbursement inequities for female-specific procedures like fibroid removal or endometriosis surgery have far-reaching implications for healthcare providers, health systems and patients. They also have a substantial impact on technology innovation in these areas — because when procedures for women are valued less, it can lead to less investment and innovation in women’s health.
Quote from Dr. Jocelyn Fitzgerald, MD, URPS, FACS
“This pattern of reimbursement inequity has held steady for decades. Some earlier reports suggested things might be getting better, but our data shows that’s not the case. If anything, the gap may be widening.”
Lower valuation of women’s procedures leads to staffing shortages and less OR time, impacting patient care
Lower reimbursement for women’s procedures disincentivizes healthcare systems from providing gynecologic surgeons with necessary resources, such as operating room (OR) time, facilities and staff allocation. The impact for patients? Longer wait times for surgery and potentially worse outcomes.
“In gynecologic surgery we often run into staffing shortages, and we need to reach out to travel nurses or nurses from other facilities to step in and help,” said Dr. Fitzgerald. “This is different from what we see with some other specialties, where oftentimes it’s a highly efficient team of the same people every day, with few staffing changes. I think patients get better outcomes because their surgeries are more efficient.”
Sometimes, the lack of reimbursement for certain female-specific procedures can prompt healthcare facilities to stop offering them altogether simply because they aren’t as lucrative as other types of surgery. Surgeons then need to find another facility to operate in, which can also contribute to substantial delays for patients.
Lower investment means fewer innovations for patients who could benefit
When women’s health is treated as lower value, progress in healthcare research and investment in technology innovation to address female-specific conditions also slows.
An example is endometriosis, a condition that affects almost 200 million women globally where tissue similar to the lining of the uterus grows outside the uterus. It can cause pelvic and urinary pain, heavy and painful periods, and infertility. The only definite way to diagnose the condition is through surgery, and this has remained relatively unchanged for decades. There is no cure for endometriosis and treatment is often limited to pain and symptom control.
This lack of progress and investment in endometriosis care is also reflected in the insurer reimbursement rates in the study, where biopsies of the endometrium are generally reimbursed less than biopsies of the male prostate.
Quote from Dr. Louise King, MD, JC, FACS
“So again, it’s the women — those who can’t get out of bed because of fibroid pain or who couldn’t realize their dream of starting a family because of endometriosis — who are the ones absorbing the impact of the severe undervaluation of gynecologic care.”
While the “Price and Prejudice” study focused on male- versus female-specific procedure reimbursement in the U.S. based on the rates used by the Centers for Medicare & Medicaid Services, underinvestment in women’s health overall remains a major issue around the world.
Despite making up roughly half of the world’s population and being the primary caretakers for their families, women’s health receives just 5% of global healthcare research and development funding.1
Disparities in pay and resources negatively impact the pipeline of future gynecologic surgeons
Women make up the majority of gynecologic surgeons, who are among the lowest paid surgeons in medicine despite completing extensive training similar to other surgical specialties.
“What we’re seeing is this concept of ‘double discrimination,’ where women who have historically been paid less than their male counterparts are also operating in a specialty that continues to be valued less because it focuses on women,” said Dr. King. “And that can have a substantial impact on the number of skilled surgeons entering the field.”
Half of U.S. counties lack a single OB-GYN,2 and the projected shortage is expected to worsen as the population of the country expands.3 And with a growing need for providers focused on gynecologic surgery, patients may have a more difficult time finding specialists who perform gynecologic procedures on a frequent basis (high-volume surgeons) and may have lower complication rates as a result, shared King.
A call to action for the public
Closing the gap in reimbursement of female-specific procedures in the U.S. could open the door to more investment and innovation in women’s health and better overall care for women. But how do we get there?
Dr. Fitzgerald and Dr. King both emphasize that the solution is complex and multi-faceted, requiring action from government entities, the broader medical community, the healthcare industry and many others — but at its core is increasing public awareness and advocacy.
“I think women are angry because they’re experiencing the effects of these inequities but may not necessarily know what would need to change to make progress,” said Dr. Fitzgerald, emphasizing the power of combined voices, especially in today’s social media age.
“That’s why this conversation about prioritizing women’s health is so important — not just on Capitol Hill but among the general public and the patients who are the most impacted.”
Dr. Jocelyn J. Fitzgerald, MD, URPS, FACS specializes in urogynecology and practices at University of Pittsburgh Physicians, Department of Obstetrics and Gynecology.
