The ‘Double Discrimination’ in Medical Billing: Why Women’s Health Procedures Pay Less

A Persistent Pay Gap

For decades, medical professionals have grappled with a systemic issue that has been dubbed “double discrimination.” The term, coined by bioethics professor Katie L. Watson, refers to the dual reality that gynecologic surgeons—who are predominantly women—are consistently paid less for their services than their counterparts performing comparable procedures on male anatomy. This disparity persists even when controlling for factors such as rank, age, and specialty.

The issue was highlighted as early as 1997 in the journal Gynecologic Oncology, in a paper titled “Is Adam worth more than Eve?” The study found that doctors were reimbursed approximately 44 percent more for male-specific procedures than for analogous female-specific ones. Despite the passage of nearly three decades, experts note that this inequality has not only remained but has become institutionalized within the billing codes that govern the healthcare industry.

The Mechanics of Valuation

The financial valuation of medical procedures is determined by the Centers for Medicare and Medicaid Services (CMS), which utilizes a metric known as relative value units (RVUs). These units are intended to reflect the time, skill, and intensity required for a specific procedure. Because private insurers often align their reimbursement rates with these federal figures, the RVU serves as a primary driver of physician compensation.

The process for setting these values often relies on self-reported surveys from medical societies, where doctors estimate the effort involved in their own procedures. A 2023 study from the Mount Sinai Health System, titled “Price and Prejudice,” analyzed 55 pairs of sex-specific procedures. The researchers discovered that 75 percent of the procedures performed on female patients carried lower RVUs. On average, male-specific procedures were valued 30 percent higher, leading to roughly 26 percent higher compensation for surgeons in hospital or surgical center settings.

A concrete example of this disparity is found in biopsy procedures. According to 2023 data, the standard national reimbursement rate for a penile biopsy was $121.32, while a vaginal biopsy was reimbursed at just $65.74.

Consequences for Patient Care

The impact of these billing discrepancies extends beyond the bank accounts of individual surgeons. When gynecological procedures yield lower financial returns, hospitals face a disincentive to invest in women’s health services. This can result in a reduction of available resources for these departments and, critically, a decrease in training opportunities for the next generation of surgeons specializing in women’s health.

The Path Toward Reform

While the problem is deep-seated, advocates like Dr. Louise King and Katie L. Watson argue that it is not insurmountable. Healthcare billing is a dynamic system; procedures are frequently reevaluated, and new codes are added as medical practices evolve. For instance, significant changes to maternity care billing are scheduled for next year, which will reorganize how prenatal, delivery, and postpartum services are reimbursed.

However, experts emphasize that gynecologic surgery—which encompasses the majority of a woman’s life outside of childbearing—remains largely absent from these reform conversations. To close the gap, advocates suggest that medical societies and federal regulators must move toward removing sex-specific billing codes and fundamentally reconsidering how the value of gynecologic procedures is calculated.

Source: vox.com