Governing the OR: How Do Political and Regulatory Landscapes Influence Pediatric Urology Surgery Costs?

OBJECTIVE: To examine potential associations between state-level policy factors and hospital-rate prices for pediatric urology procedures. METHODS: Hospital-specific pricing data for specific pediatric urology procedures were obtained from the Turquoise Health Database in 2025. Hospital rate (payer-specific facility fee after discounts or negotiations excluding professional fees) for various pediatric urology procedures was linked to state-level policy variables for each state including political lean, Medicaid expansion, certificate of need (CON) laws. Multivariable regression assessed associations between prices and predictor variables. RESULTS: 56 US pediatric hospitals reported prices. Median procedure price was $5,905. No significant pricing differences were found between Democratic versus Republican leaning states across most procedures, except for hydrocelectomy (lower in Republican-leaning states by -$1,530; p < 0.05). Medicaid expansion and CON status showed no significant association with pricing. However, states leaning either Democrat or Republican had significantly lower negotiated rates (47% and 46%) than centrist states when adjusting for relevant factors (p=0.008, p<0.001). CONCLUSION: Although variation exists for US pediatric urology procedure pricing, it appears largely unrelated to state-level policy factors, which contrasts with findings in other surgical subspecialties. This may challenge assumptions that state-level policy reforms significantly address cost variation, underscoring the need for further research into hospital-level drivers of pricing.