Goff B A, Muntz H G, Cain J M
University of Washington Medical Center, Department of Obstetrics and Gynecology, Seattle 98195, USA.
Gynecol Oncol. 1997 Mar;64(3):372-7. doi: 10.1006/gyno.1996.4607.
On January 1, 1992, Congress implemented a Medicare payment system based on relative value units (RVU). The RVU multiplied by a dollar conversion factor sets the reimbursement for all procedures covered by Medicare and many other private insurers. This study was undertaken to evaluate discrepancies in federal reimbursement for gender-specific procedures.
Using the December 1995 Federal Register and the regional Medicare conversion factor ($40.08/RVU), we compared the work RVU and total reimbursement of 24 groups of gender-specific surgical procedures. The groups were matched as carefully as possible so that the amount of work and level of difficulty would be similar, if not identical. Some examples of comparisons are as follows: biopsy of male vs female genitals, hysterectomy vs prostatectomy, staging for ovarian vs testicular cancer, and exenteration for cervical vs prostate cancer.
In the 24 matched procedures, the male-specific procedures were reimbursed at a higher amount in 19 (79%) cases. The female-specific procedures were reimbursed at a higher amount in 3 (12%) cases (P = 0.004). There was no difference in reimbursement for two of the comparisons. Overall, we found that male-specific procedures are reimbursed at an amount which is 44% higher than female-specific procedures. Comparison of work RVU revealed that male-specific procedures were assigned higher values in 19 cases and, overall, male gender-related surgeries had work RVU that were 50% higher than female gender-related surgeries.
There is significant gender bias against the Medicare reimbursement of female-specific services. This results in a lower net reimbursement for gynecologic procedures. In addition, since many private sector insurance carriers now use the resource-based relative value scale system, this gender bias is further potentiated.
1992年1月1日，国会实施了基于相对价值单位（RVU）的医疗保险支付系统。相对价值单位乘以美元换算因子确定了医疗保险和许多其他私人保险公司承保的所有程序的报销金额。本研究旨在评估针对特定性别的程序在联邦报销方面的差异。
利用1995年12月的《联邦公报》和地区医疗保险换算因子（40.08美元/RVU），我们比较了24组特定性别的外科手术程序的工作相对价值单位和总报销金额。这些组尽可能仔细地进行了匹配，以便工作量和难度水平即使不完全相同也相似。比较的一些例子如下：男性与女性生殖器活检、子宫切除术与前列腺切除术、卵巢癌与睾丸癌分期以及宫颈癌与前列腺癌的脏器清除术。
在24项匹配的程序中，19项（79%）男性特定程序的报销金额更高。3项（12%）女性特定程序的报销金额更高（P = 0.004）。两项比较的报销没有差异。总体而言，我们发现男性特定程序的报销金额比女性特定程序高44%。工作相对价值单位的比较显示，19项男性特定程序被赋予了更高的值，总体而言，与男性性别相关的手术的工作相对价值单位比与女性性别相关的手术高50%。
在医疗保险对女性特定服务的报销方面存在明显的性别偏见。这导致妇科程序的净报销较低。此外，由于现在许多私营部门保险公司使用基于资源的相对价值尺度系统，这种性别偏见进一步加剧。
