Cryptocurrency is a rapidly evolving method of payment that is secured by blockchain technology. It provides a decentralized form of payment between consumer and provider of goods or services that is neither traceable nor identifiable by a third party. In recent history, cryptocurrency has been utilized across the world to purchase various tangible products including jewelry, cars and boats. In fact, several well-known international corporations have begun to accept cryptocurrency in recent years.¹ Interestingly, cryptocurrency has more recently penetrated into the health care industry as a form of payment in exchange for clinical services rendered. Many medical services are traditionally paid for as out-of-pocket costs, meaning that the consumer’s health care insurance policy does not universally cover costs for these select services. Examples include, but are not limited to, concierge medical care, aesthetic plastic and reconstructive surgeries, dermatological skin care procedures, and even some forms of novel cancer treatments. It is understood that these out-of-pocket medical services for individual patients are kept private under Health Insurance Portability and Accountability Act (HIPAA) protections; however, payment with traditional currency, such as the United States dollar, leaves an identifiable paper trail between consumer and provider, thereby limiting true security and confidentiality, which would be rendered fully anonymized with cryptocurrency use as a payment form. Recent history suggests that patients are already using cryptocurrency in select medical fields as a way to combat traceable transactions for medical care services that may be considered more scrutinized or judged by today’s society.

The forefront of cryptocurrency adaptation in the health care industry lies within the field of plastic and reconstructive surgery. Many plastic and reconstructive surgeons across the world are currently accepting cryptocurrency as a valid form of payment.^2,3 Alongside plastic surgery, dermatology clinics are also beginning to accept cryptocurrency.⁴ These respective medical practices are meeting the demand of a patient population that desires a secure, unidentifiable way to pay for medical services. It is of strict importance that urologists and urology practices identify this alternative payment as a potential avenue for patient security and consider offering cryptocurrency as an accepted form of monetary transaction. Doing so delivers a patient-centered approach to health care and gives urological patients peace of mind that their services can be paid for in a secure, convenient manner. Of note, a urology practice in the Czech Republic recently began accepting cryptocurrency as a form of payment in 2021.⁵

It is important to understand that many common urological procedures are not covered by health care insurance.^6,7 For example, the mean out-of-pocket cost of an in vitro fertilization was as high as almost $20,000 in 2013.⁷ While the monetary requirement of the procedure is striking, it is as important to note the sensitive nature of the service provided. For health care conditions or services that may serve as a source of psychological distress, patients may feel more comfortable and secure paying for these services if the privacy of this care could be guaranteed beyond the securities of provider–patient confidentiality, but also in the realm of payment tracing. Other procedures that are typically paid for out-of-pocket within the discipline of urology include infertility services including assisted reproductive techniques, cryopreservation of sperm, vasectomy reversals, some novel forms of benign prostatic hyperplasia treatment and certain forms of focal ablative prostate cancer treatment, among others.⁷

While cryptocurrency is already being utilized in multiple medical fields, it naturally has skeptics and is the source of much criticism. Furthermore, there is inherent uncertainty and ambiguity with cryptocurrency when compared to traditional, tangible forms of government-backed currencies used for payment, such as the U.S. dollar. Cryptocurrencies are a reliable source of currency for many consumers due to their direct exchange rates between the virtual currency and the respective patients’ centralized government currency.⁸ Of course, cryptocurrency does tend to fluctuate in value, but current trends suggest increasing acceptance internationally. In 2021, El Salvador accepted Bitcoin as a legal tender.⁹ While many providers may have varying opinions on cryptocurrency, it needs to be critically evaluated given its potential future global adoption and role in medical payments.

It is also important to consider the integration of cryptocurrency in out-of-pocket health care services and the many barriers that may influence this. For instance, how will cryptocurrency evolve in different countries whose medical care is funded largely by a national public health system as a single payer? Canada, for one example, employs a universal health care system with the option to opt in for private health care insurance in the event that one elects to and has the financial means of doing so.⁹ Such a health care system may potentially permit for a more rapid expansion of cryptocurrency as an avenue for health care payment. Urologists and other health care providers in countries that give opportunity for supplemental health care in addition to baseline universal health care should look to accept cryptocurrency payment in preparation for those who are willing to pay a premium for out-of-pocket concierge level health care. Nevertheless, all countries that provide urological health care should expect an increase in the demand for cryptocurrency as a valid source of payment due to its increasing availability, acceptance and privacy.

The nuances of privacy within health care services in regard to cryptocurrency extend far beyond the purpose of this article. However, it is important to note that it is well within reason to believe that cryptocurrency will become a viable form of payment within health care in the near future due to its heavily encrypted nature. For now, this article illuminates the increasing probability of urological patients inquiring about cryptocurrency as a form of out-of-pocket payment sometime in the future, potentially very soon. With the advent of health care practices in dermatology, plastic surgery and other surgical specialties with elective procedures like urology, validating cryptocurrency as a valid form of monetary transaction, current and future urologists should recognize cryptocurrency as an opportunity for business growth and marketing and be appropriately poised for this technological shift.