State Health Care Regulations and Political Affiliation Associated With Total Hip Arthroplasty Prices Across the United States.

BACKGROUND: Given that total hip arthroplasty (THA) is an elective procedure with rapidly increasing volumes (projected increase of 350% by 2050) and predictable costs, it is uniquely suited to serve as a proxy for assessing price transparency of hospital services. This study investigated the association between THA pricing and state characteristics, including political affiliation, Medicaid expansion status, certificate of need (CON) status, and gross domestic product per capita. North Carolina Area Deprivation Index (ADI) as well as urbanization are also considered. It was hypothesized that hospitals in states with Democratic partisanship, CON laws, and Medicaid expansion would exhibit lower prices. METHODS: The THA price data were extracted using Current Procedural Terminology code 27130. The study included 2,226 hospitals nationwide. The median (interquartile range) price of THA across these hospitals was $12,465.46 ($6,864.69). The degree of state partisan lean was calculated by evaluating state characteristics during the 2020 election year, including presidential vote, senate majority, house majority, governor affiliation, and insurance commissioner affiliation. Multivariable regression models were used to assess the relationship between these factors and THA price. RESULTS: Hospitals in Democratic-leaning states were associated with a significantly lower price of -$72.79 (P < 0.001). Medicaid expansion and CON status were also associated with a reduction in the price of -$491.39 (P < 0.0001) and -$546.73 (P < 0.0001), respectively. In North Carolina, an ADI > 85 was associated with a reduction in the price of -$3,672.60 (P = 0.0033), while urbanization was not significantly associated (P = 0.34). CONCLUSIONS: Total hip arthroplasty (THA) prices are lower in states with Democratic leadership, Medicaid expansion, and CON laws. An ADI > 85 was also associated with reduced THA prices. These findings underscore the complexity of health care pricing and the important role state policies and socioeconomic factors play in determining costs. LEVEL OF EVIDENCE: III.

Duke Scholars

Author Sean Ryan Orthopaedic Surgery

Author Thorsten Markus Seyler Orthopaedic Surgery

Author Christian Pean Orthopaedic Surgery