Reimbursement inequities lead to hospitals deprioritizing women’s healthcare, experts tell Congress

Inequities don’t exist only in the quality of healthcare women receive but also in how that care is reimbursed, according to a group of experts speaking before Congress on April 29.

The group—which included ob-gyn experts from Harvard, Northwestern, and more—held a briefing to say systemic inequities within the healthcare reimbursement system lead to providers making more money for some procedures performed on male anatomy than those performed on female anatomy, and therefore, those procedures on male anatomy get prioritized.

“A lot of people say, ‘Oh, you’re doing as much work, but do you have as much training? Do you have as much expertise? Are your procedures as complicated?’ It’s very easy to think that women’s issues are not as complicated or that their surgeons are not as well trained, and that is not that case,” Jocelyn Fitzgerald, a urogynecologist at the University of Pittsburgh Medical Center, said during the briefing.

Some background. The amount of money a hospital makes for a surgery is partially based on what are called relative value units (RVUs).

While RVUs technically only apply to patients enrolled in Medicare, other insurers tend to mirror the system when determining their reimbursement rates, too, according to Louise Parker King, assistant professor of obstetrics, gynecology, and reproductive biology at Harvard Medical School.

Unequal payments. During the briefing, experts called out several disparities in the reimbursement system.

For one, when RVUs were developed, “there was very little work put into quantifying the work of surgeons who cared for women,” Parker King said during the hearing.

Gynecologists “were adjudicated to have less required skill” compared to other specialists like cardiologists or orthopedists, she added, so RVUs for procedures involving female anatomy were generally set lower than those involving male anatomy.

More than 100 codes for surgeries performed on female anatomy were reimbursed an average of 30% lower than similar surgeries performed on male anatomy, according to a 2025 study.

The researchers found that surgery on a male urinary tract makes on average 35% more than surgery on a female urinary tract, Fitzgerald said. Biopsying a penis brings in 45% more than biopsying a vagina, she added.

Beyond the overall lower RVUs, there simply aren’t many RVUs to bill for some procedures on female anatomy, according to Fitzgerald. Endometriosis surgery, for example, has only a single RVU.

“Surgical facilities are not going to want to give a surgeon who’s billing one low reimbursement code an operating room for eight hours if [an] orthopedic surgeon can do 16 shoulder surgeries in that time and make 16x the amount of money,” she said.

Next steps. The experts said Congress could take action to eliminate these inequities.

Lawmakers could pass legislation requiring the Centers for Medicare and Medicaid Services (CMS) to use “objective measures” when setting RVUs rather than reimbursing procedures differently based on whether they’re performed on male or female anatomy, Christopher Robertson, a health law professor at Boston University, said.

Congress could also write to CMS about the issues laid out during the briefing and press the agency to explain why such disparities exist as well as hold formal hearings to raise awareness, Robertson added.

Overall, “this idea that gynecologic surgery isn’t valuable has profound, significant downstream consequences,” Oluwateniola Brown, assistant professor of obstetrics and gynecology at Northwestern University, said during the hearing. “It’s not about professional recognition…It’s about a systemic inequity that threatens the financial sustainability of health systems, the viability of our workforce, and most importantly, access to care and the quality of care for our patients.”