January 22, 2014 | 42
Physicians have debated for years whether to cut foreskin. It’s unclear whether potential benefits of circumcision—greater prevention of health problems such as urinary tract and HIV infections, STDs and penile cancer—outweigh the risks of surgery. Many parents adhere to national guidelines from the American Academy of Pediatrics (AAP), which in 1999 deemed circumcisions as medically unnecessary. Florida and 11 other state governments also followed AAP’s stance when they decided to drop the procedure from Medicaid coverage.
These states, however, may have defeated their own cost-savings efforts, a Wall Street Journal report noted this week. A University of Florida Health study showed that between 2003 and 2008, a period just a few years after Florida stopped coverage, the number of older boys who required circumcisions rose sharply. Such surgeries often take place because of concerns about urinary-tract or penile infections, which are less common among their circumcised equals.
At the same time, statewide spending on circumcisions skyrocketed. The surgery for older boys can cost up to $6,000 compared with as little as $250 for newborns. The study found that Medicaid spending on circumcisions for patients up to age 17 climbed from $14.9 million to $33.6 million between 2003 and 2008. Beyond money, the procedure poses a greater risk of complications and causes more pain for older boys than for newborns.
Circumcision rates in older boys may have increased in Florida for a number of reasons. For instance, more parents may have simply decided against the procedure for their newborns in the wake of the AAP’s 1999 report. But many patients’ parents said they would have circumcised their sons at birth, rather than later in life, if Medicaid covered the procedure for newborns, according to University of Florida Health pediatric surgeons.
In 2012, the AAP revised its stance and concluded that, although it does not recommend routine circumcisions, the most recent science indicates that health benefits of circumcisions justify the risks. The AAP advised that families should have the option to circumcise their sons affordably and admitted that it “had not forseen that [the 1999] statement would lead to a decrease in insurance coverage,” said AAP member Douglas Diekema in the Wall Street Journal story. Whether Florida and other states will ultimately decide to reinstate Medicaid funds for newborn circumcisions—either out of concern for young males or for the government checkbook—remains to be seen.