Circumcision rates lower in states where Medicaid does not cover procedure

January 28, 2009

Hospitals in states where Medicaid does not pay for routine male circumcision are only about half as likely to perform the procedure, and this disparity could lead to an increased risk of HIV infection among lower-income children later in life, according to a UCLA AIDS Institute study.

Researchers found that at hospitals in the 16 states where the procedure is not covered, circumcision rates were 24 percentage points lower than at hospitals in other states, with lower rates particularly prevalent among Hispanics. The mean male circumcision rate for all states was 55.9 percent.

The study, published in the January issue of the American Journal of Public Health, is available online at www.ajph.org/cgi/content/full/99/1/138.

The findings are important because they document the effect of state Medicaid reimbursement policies on the medical services that are actually delivered, said the study's lead author, Arleen A. Leibowitz, a professor of public policy and a researcher with both the UCLA Center for HIV Identification, Prevention and Treatment Services and the UCLA AIDS Institute. These services include male circumcision, which has been shown to lead to substantial health benefits in later life.

"Since children whose childbirth expenses are paid for by Medicaid are, by definition, lower income, the Medicaid policy in 16 states of not reimbursing for male circumcision is generating future disparities in health between children born to rich and poor families," Leibowitz said.

In 1999, the American Academy of Pediatrics (AAP) stated that the medical benefits of male circumcision were not enough for the group to recommend that the procedure be made
routine at all hospitals. As a result, some states began withdrawing Medicaid coverage for circumcision.

But recent clinical trials in South Africa, Kenya and Uganda have revealed that male circumcision can reduce a man's risk of becoming infected with HIV from a female partner by 55 to 76 percent. In June 2007, the AAP began reviewing its stance on the procedure.

The UCLA researchers relied on data from the 2004 Nationwide Inpatient Sample (NIS), collected as part of the Healthcare Cost and Utilization Project of the federal Agency for Healthcare Research and Quality. They studied information on about 417,000 routine discharges of newborn males from 683 U.S. hospitals.

In addition to the overall lower circumcision rates, the researchers found that the more Hispanics a hospital served, the fewer circumcisions the hospital performed. For Hispanic parents, the circumcision decision was about more than simply cost, since male Hispanic infants were unlikely to receive the procedure even in states in which it was fully covered by Medicaid.

The 16 states without Medicaid coverage for male circumcision are California, Oregon, North Dakota, Mississippi, Nevada, Washington, Missouri, Arizona, North Carolina, Montana, Utah, Florida, Maine, Louisiana, Idaho and Minnesota.

The study authors estimate that if all states' Medicaid plans paid for male circumcision, the national rates for the procedure would increase to 62.6 percent. If all states dropped the coverage, the rate would fall to about 38.5 percent.

"State Medicaid plans that attempt to reduce costs in the short run by not covering the cost of infant male circumcision may be generating higher health care costs for HIV/AIDS and other sexually transmitted infections in the future," Leibowitz said.

Source: University of California - Los Angeles


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  • KBK - Jan 28, 2009
    • Rank: 5 / 5 (1)
    Circumcision is a religious affliction/affectation from the days of yore and has no place in a modern society. Genital scarring due to religious beliefs belongs back in the stone age where it means something for them.

    But not here.

    Look at the names involved and look at their backgrounds. Don't believe this bullshit without investigating.

    You will find conclusions (study results) in countries that do not have the religious affectation tied to the study -- and they will have opposite conclusions.

  • ml66uk - Jan 28, 2009
    • Rank: 5 / 5 (1)
    No surprise that if people have to pay for something they're less likely to do it. The real question is why is Medicaid paying for this in any state.

    This statement is simply false, or controversial at best: "These services include male circumcision, which has been shown to lead to substantial health benefits in later life."

    Canadian Paediatric Society
    http://www.cps.ca...6-01.htm
    "Recommendation: Circumcision of newborns should not be routinely performed."

    http://www.caring...regnancy&babies/circumcision.htm
    "Circumcision is a "non-therapeutic" procedure, which means it is not medically necessary.
    ...
    After reviewing the scientific evidence for and against circumcision, the CPS does not recommend routine circumcision for newborn boys. Many paediatricians no longer perform circumcisions."

    Royal Australasian College of Physicians
    http://www.racp.e...A1BAF527
    "After extensive review of the literature the Royal Australasian College of Physicians reaffirms that there is no medical indication for routine neonatal circumcision."
    (those last nine words are in bold on their website, and almost all the men responsible for this statement will be circumcised themselves, as the male circumcision rate in Australia in 1950 was about 90%. %u201CRoutine%u201D circumcision is now *banned* in public hospitals in Australia in all states except one.)

    British Medical Association
    http://www.bma.or...Document&Highlight=2,circumcision#Circumcisionformedicalpurposes
    "to circumcise for therapeutic reasons where medical research has shown other techniques to be at least as effective and less invasive would be unethical and inappropriate."

    National Health Service (UK)
    http://www.nhsdir...leId=649
    "Many people have strong views about whether circumcision should be carried out or not. It is not routinely performed in the UK because there is no clear clinical evidence to suggest that it is has any medical benefit."

    South African Medical Association
    "from a medical point of view, there is no medical justification for routine circumcision in neonates and children." 2007
  • andyrdj - Jan 28, 2009
    • Rank: 5 / 5 (1)
    Circumcision should not be touted as an AIDS preventative measure, far better to improve testing and condom usage.

    Also, why is it anyone's choice but a grown man's for his own penis? I find it abominable that parents should have the right to choose to sever a part of
    their child's anatomy, particularly one in such an intimate personal area.

    What if it were the left eye, or a couple of fingers? Would religion still be an allowable precedent for it?

    Our bodies and our choices belong to US, not our parents!!!

January 28, 2009 all stories

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3.8 /5 (4 votes)
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