Sex differences in care complexity and cost of cardiac-related procedures as a basis for improving hospital payments systems

Shuli Brammli-Greenberg*, Sharvit Fialco, Neria Shtauber, Yoram Weiss

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


In this study, we estimate sex differences in care complexity and cost of cardiac-related procedures in order to demonstrate the importance of sex as a risk adjuster in a hospital payment system. We use individual visit-level data for all adult Israelis who underwent either heart valve surgery (HVS) or coronary artery bypass graft surgery (CABG) during the period 2014–2018 in publicly funded hospitals. We find that women undergoing a cardiac-related procedure are more likely to die during hospitalization, they have longer hospital stays, and overall, they are more likely to be care-complex than men. Furthermore, the cost of the surgery itself is higher for women than for men in the case of HVS (though not CABG), and the cost of the post-operative hospital stay is higher in the case of CABG (though not HVS). It is concluded that sex differences should be considered in the calculation of payment for cardiac-related procedures in order to reduce incentives for selection and reduce unwarranted variation in cardiac-care utilization and medical practice.

Original languageAmerican English
Pages (from-to)539 - 556
Number of pages18
JournalEuropean Journal of Health Economics
Issue number4
StatePublished - Jun 2023

Bibliographical note

Funding Information:
The study was funded with the assistance of the Government of Israel and the Myers-JDC-Brookdale Institute. We are grateful to John Armstrong, Konstantin Beck, John Bertko, Sylvia Demme, Rudy Douven, Randy Ellis, Jacob Glazer, Lukas Kauer, Thomas McGuire, Sonja Schillo, Erik Schut, Christian Schmid, Maria Trottmann, Wynand Van de Ven, Juergen Wasem, and participants in the Risk Adjustment Network 2021 Annual Meeting (in Weggis, Switzerland) for helpful comments and discussion. We also thank Merav Kaplan at the Myers-JDC-Brookdale Institute for her initial work on data curation and Prof. Bruce Rosen for his comments on the final draft. We also thank Yaacov Diskin, Senior information Analyst at HMC, and to the Information Division of the Israeli Ministry of Health for the initial contracting and de-identifying of the datasets.

Publisher Copyright:
© 2022, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.


  • Cardiac-related procedures
  • Hospital payment
  • Risk-adjustment
  • Sex


Dive into the research topics of 'Sex differences in care complexity and cost of cardiac-related procedures as a basis for improving hospital payments systems'. Together they form a unique fingerprint.

Cite this