Circumcision Rates Lower In States Where Medicaid Does Not Cover Procedure

Ruzanna Harutyunyan's picture
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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 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.

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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.

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Comments

There is always the problem of lack of consent. Because of the lack of consent circumcision of children (who do not medically require it) is unethical and should be banned. "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. Leibowitz, is out of touch with reality. In the Western world there has been movement away from surgically removing sexual anatomy from males when they are babies because the very same health benefits can be achieved through very basic means. Moreover, in the USA, thousands of baby boys would have to be circumcised to prevent one HIV/AIDs infection that could have been prevented via basic safe sex education. Many of these males might object to having part of their healthy sex anatomy removed in infancy without their consent for parental-social reasons, rationalized through this entirely disproportional prevention argument. <br> <br> Centers for Disease Control and Prevention (CDC): Risk Factors for HIV Transmission: You may be at increased risk for infection if you have * injected drugs or steroids, during which equipment (such as needles, syringes, cotton, water) and blood were shared with others * had unprotected vaginal, anal, or oral sex (that is, sex without using condoms) with men who have sex with men, multiple partners, or anonymous partners * exchanged sex for drugs or money * been given a diagnosis of, or been treated for, hepatitis, tuberculosis (TB), or a sexually transmitted disease (STD) such as syphilis * received a blood transfusion or clotting factor during 1978–1985 * had unprotected sex with someone who has any of the risk factors listed above
It is hard to believe that UCLA would be involved in any way with encouraging any kind of Child Abuse! No one should have a part of their body forcibly removed because of the "religious" beliefs selectively claimed by a parent, or because the previously abused father wants his son to look like him. Thank God that most of the world outside the USA realizes that there is no good reason to remove a healthy part of a child’s body. Has anyone suggested that Arleen A. Leibowitz remove those portions of her skin that have been exposed to sunlight to lessen their chance of developing cancer, or non-essential parts of her body that are know to have higher rates of malignancies? And we call ourselves civilized?
That would be perfect if all states dropped coverage for infant circumcision. As the AAP notes, it's not a necessary surgery. With the current economy, Medicaid needs to look for ways to save money by dropping unnecessary procedures. The purported protective effect circumcision has against HIV transmission is only female to male in unprotected sex. In USA there's more danger from anal sex and shared IV drug needles. Americans also have better access to condoms and safe sex education. Again, medicaid should stop wasting taxpayers' money on elective penis surgery.
This study is really an opinion piece. The number of circumcisions is droping because people don't want to rip tissue from tissue on babys and have them lose protective fumnction and lose the most sensitive part of the penis. The surgery removes over 10,000 nerve endings. As many people in the US (over 3/4 ?) don't have these nerve endings, it is difficult to understand. It is like having finger tips or lips removed. It is not just skin. There are many myths. An Asian study noted that circumcised men had a higher premature ejaculation probem, probably because the most sensitive part (the scar) gives false signals to the brain. Men get ED at a younger age after losing the sensory function. A must is to consider sexual health and why ever mess with the most sensitive a part of the genitals? A real fact is that the chance of the baby getting MRSA (staph) from the circumcsion in a hospiital is HIGHER than the chance of getting HIV through ones whole life. Both ratees are low. The chance of a boy losing the most sensitive part from circ is 100%. Baby boys would most certainly choose as grown men do, to keep all of their penis. Don't take away the most sensitive part of another human beings genitals.
Arleen A. Leibowitz - gotta be jewish with a name like that. Hey Jewlady - you may not respect other people's right to their whole body - but I do. There is no evidence that circumcision is a net benefit. The UK doesn't cirumcise - hasn't done since the 1950's - and there have been no problems. In fact, the Uk and other countries in Europe, have a lot lower rates of all kinds of conditions.
Being disrespectful of the Jews gets no one anywhere. While it is true that Halperin, and Leibowitz are Jewish names, there are a lot of other people who are calling for circumcision. That guy Brian Morris in Australia is positively frothing at the mouth to fight circumcision. Edgar Schoen in the US finally was eased off the panel on circumcision on the AMA, which in turn led to their going from pro-circumcision to a neutral stance. He is a person who wrote the poem "Ode to Circumcision". I can only imagine how much balance and objectivity he brought. These African studies are incomplete. Of the people who completed the study, these are the numbers. They don't include the HIV status of many circumcised men, who left, and were never heard from again by the doctors conducting the study. When you have had 2/3 of the sense receptors of your penis removed, it might be hard to admit that you may have made a mistake. Routine circumcision in the US benefits no one, but possibly the doctor who performs it. No one seems to want to mention that this violates the "first, do no harm" ethic of medicine, or that the doctor is removing healthy tissue from an unconsenting person (shades of the Nazi Dr. Mengele). The doctor can then sell the foreskin to a biotech company, without the parents' knowledge, and make a tidy profit. Odd, that women who profess to be grossed out by a foreskin, will buy a product made of foreskins to put on their faces, let alone that they have clitoral foreskins which perform the same protective function as the male foreskin. There is enough ignorance to go around. This opinion piece is one of them. Ever notice that there is never a well funded study of circumcision in the US? The US points to Africa, and uses it to push circumcision. Yet, the US has a high rate of circumcision, and a high rate of HIV infection. Why is this? Perhaps, it would be bucking the American tradition built up by years of the medical community selling us circumcision through propaganda. Originally, it cured epilepsy, insanity, and masturbation. When those were disproven, it then prevented uterine cancer. Never mind that the theory was that smegma was the culprit, and women produce more of it in their vulvas than men do in their penises. Perhaps it is because circumcision is an estimated $250 million dollar cash cow. There is no rational, well thought out reason, to wound a baby, and remove half the skin from his penis. Why are we so hypocritical about female circumcision, as compared to male circumcision? I don't know. Female circumcision has been shown to lower the rate of HIV infection. Why is no one running out to have it done to their daughter? Because it is cruel, and robs them of a great deal of sexual sensation. What about male circumcision? It took the deaths of several children to mobilize Canada, to dump circumcision. Britain used to do it commonly until WWII. Australia and New Zealand have pretty much stopped. Why would an otherwise reasonable country like the US continue this cruel, painful, pointless practice? We can't do it to a girl, or dock a dog's tail in most areas, but a baby boy is a target. If you are really thinking about his own good, don't rob him of what nature intended him to feel...his whole body.
This page doesn't seem to let me post the links, but you can find all this stuff online at these organizations' own websites: Canadian Paediatric Society "Recommendation: Circumcision of newborns should not be routinely performed." "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 "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%. "Routine" circumcision is now *banned* in public hospitals in Australia in all states except one.) British Medical Association "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) "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 it has any medical benefit." See also: Canadian Children's Rights Council "It is the position of the Canadian Children's Rights Council that 'circumcision' of male or female children is genital mutilation of children."