If Circumcision Rates Keep Falling, Health Costs and Infections Will Spike

As more and more states' Medicaid programs cut coverage for circumcision, researchers take a look at the potential fallout

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If rates of circumcision among infant boys continue to drop in the U.S., it could lead to billions of dollars in added health care costs and increases in sexually transmitted infections among men, according to a recent study by Johns Hopkins researchers.

Studies link circumcision with numerous health benefits: the procedure is associated with lower risks of urinary tract infections in babies and young boys, and reductions in men’s risk of contracting HIV, genital herpes and human papillomavirus (HPV); it may also help reduce the odds of penile and prostate cancers. By reducing the burden of sexually transmitted infections among men, it may also help keep more women infection-free as well.

If circumcision rates were to drop from the current 55% to 10%, urinary tract infections in baby boys may rise a whopping 212%, and in men, HIV infections could increase by 12%, HPV infections by 29% and herpes simplex virus type 2 by 20%. In women, dropping rates of male circumcision could increase cases of bacterial vaginosis by 18% and low-risk HPV by 13%.

(MORE: Study: Uncircumcised Boys Have a Higher Risk of UTI)

As gaps in insurance coverage increasingly lead parents to opt out of circumcision, the researchers say a drop to 10% is not unlikely — that’s in line with circumcision rates in Europe, where the procedure is typically not covered by insurance. Medicaid programs in many states have eliminated coverage of the procedure: currently, 18 states no longer pay for it, with South Carolina and Colorado most recently ending coverage last year. According to the study authors, the rate of circumcision rates had remained steady at about 79% between 1970 and ’80, but fell to 63% in 1999 and then dropped again to 55% in 2010.

To assess the estimated health-care costs of not circumcising, the researchers create an economic model. Their program included 4 million babies, equal to the number of kids born in the U.S. each year. Each circumcision costs insurers about $250 to $300, the researchers figured, but each time the procedure is avoided, $313 in illness-related costs can be added for doctor’s appointments, medications and other treatment for men who contract infections or develop disease as result of not being circumcised.

The authors calculate that if the circumcision rate dropped to 10%, it would increase lifetime health care costs by $407 per man and $43 per woman. Over 10 years, total additional health care costs would exceed $4.4 billion. “By health policy analysts and government officials thinking they can save money by eliminating Medicaid coverage of male circumcision, they are actually in the long run increasing the costs overall,” says study author Dr. Aaron Tobian.

But large medical bills are not the authors’ greatest concern. “We have a trillion dollar health care system, so the numbers are not huge,” says Tobian. “The bigger problem is that [without Medicaid coverage] and with private insurance carriers following the government’s rules, we are implying there are no medical benefits to this procedure.”

(MORE: How 11 New York City Babies Contracted Herpes Through Circumcision)

In addition, the authors note that populations that are most likely to qualify for Medicaid coverage currently have the lowest rates of male circumcision and often the highest rates for infections. “By decreasing Medicaid coverage for circumcision, we may be exaggerating these racial and socioeconomic disparities,” says Tobian.

He believes all state Medicaid programs and private insurers should cover circumcision, so that families can discuss the pros and cons of the procedure with their doctor, without having to worry about cost. For its part, the American Academy of Pediatrics currently says there isn’t enough evidence of the health benefits to recommend routine circumcision of infant boys. However, the pediatricians group is about to issue an updated policy statement on the issue soon, and is expected to recognize newer evidence of the benefits of the procedure.

In an editorial accompanying Tobian’s study, Dr. Arleen Leibowitz and Katherine Desmond from the University of California, Los Angeles, argue the federal Medicaid program should consider reclassifying circumcision as a required benefit, so that states facing budget constraints won’t drop the procedure. By doing so, states can reduce rates of HIV and other sexually transmitted infections, and avoid rises in medical expenses.

The study is published in Archives of Pediatrics & Adolescent Medicine.

MORE: Battle of the Bris: A Move to Outlaw Circumcision in San Francisco

128 comments
JosephLewis
JosephLewis

According to the CIA Factbook, the United States has a higher HIV prevalence rate than 53 countries in the world, where circumcision is rare or not practiced. We have more HIV than MEXICO.

Self-serving horse sh!t.

NancyWyatt
NancyWyatt

80% of the worlds males are intact & do NOT suffer the issues you listed. Dr's have a vested interest in keeping the circumcision industry alive.  Follow the MONEY!

JoeCortez
JoeCortez

Like they're spiking in Europe? Australia? Japan? Pretty much the rest of the world? Seriously, Men's Health. Precisely who do you think you're fooling? What a complete crock.

NicolaiMatz
NicolaiMatz

What a huge pile of bull.
No links to the medical studies qualifying circumcision as a benefit (because they don't exist) and no logical thinking on the part of the writer.
All we have is dr. Aaron Tobians and Leibowitz's word for it.  Other than me than gets a curious ringing in the ears when those names are linked to the ancient jewish cult ritual of genital mutilation ?

This is just another attempt of keeping the ritual alive - a ritual that should have been left in the Middle Ages where it belongs.

Meanwhile in the real world, the US. is the absolute highest (ab)user of circumcision in the Western World - and also leads the score board in every STD.  most noticably HIV, where they lead by about 400% compared to the countries doing circumcision the LEAST (Scandinavian countries)

FrederickRhodes
FrederickRhodes

Doctors who increase their prices and cause diseases to try to force people to accept their superstitious religious ritual as a health benefit will be sued out of business for fraud and collusion.

firstdonoharm
firstdonoharm

This article is chalk full of innacuracies. Most of the world does not circumcise their baby boys. American stands alone amputating a healthy genital organ for *possible* small margins of health concerns. Furthermore every health concern has more cost effective and less invasive treatment option before complete amputation. The tides have turned because Americans are reading and learning about foreskin. They are seeing through the smoke screen and money machine that circumcision is.

TaylorPrigge
TaylorPrigge

So if you don't spend $300 to mutilate your baby, he may need to spend $400 in his lifetime on foreskin related medical costs?! This is the biggest load of garbage I've ever read. Embarrassing that it comes from time. I thought you might have a more worldly view on the circumcision crisis in America. Foreskin isn't the enemy. It's poisonous ignorant garbage like this article that is damaging to health.

BarbaraJeanReggio
BarbaraJeanReggio

PS- I will be canceling my subscription to Time magazine as you obviously do not support fact based journalism.

BarbaraJeanReggio
BarbaraJeanReggio

The rest of the world doesn't circumcise and does not have an increase in any of these conditions falsely linked to having a normal penis!

MikeFerguson
MikeFerguson

Shame on you for allowing misinformation in journalism. Most of this article is completely false. However....I understand that is merely an opinion piece. It is a misguided and false opinion.

There is no excuse for genital mutilation on a non-consenting minor. Male or female. None. Nor will there ever be.

hfd
hfd

Sooo if i can cut the foreskin off a male can i cut the labia, "foreskin" of a female, off too?

oblivion328
oblivion328

Also, studies in Africa in recent years seem to refute the claims that the procedure has any measurable impact on HIV transmission rates.

oblivion328
oblivion328

Circumcision really makes no logical sense if you think about it, but there's too much money in it for healthcare professionals to admit it. From what I've read, there really doesn't seem to be any solid evidence that circumcision drastically reduces chance of infection.

JohanManyakol
JohanManyakol

In one of the studies they found that there is less bacteria on the penis of a circumcised male than a normal on. mmmm that is one of the purposes of this gland and the moisture area underneath the foreskin, to trap and disable. In one of the comments someone put it so well. Circumcision reduces risk of std's. FALSE It INCREASES the risk. Foreskin is a mucus membrane. Mucus TRAPS pathogens - it HELPS prevent disease. (Like snot in your nose prevents you from getting sick. It is what it is made for)

JohanManyakol
JohanManyakol

I do not know one single man that is circumcised in my country. There are some, but I do not know any of them. I am in the military so I do "see" a lot of naked men, of all races and I have yet to see a circumcised penis. No one I know have ever had any type of STD, no ones baby had "urine track infections" or any of that nonsense. This looks more like a money making scheme to me than a medical intervention. This is like cutting of young girls breast because they might get breast cancer. There is an old saying, if it ain't broken don't fix it. Did you know 1/77 new born male deaths in the USA is due to circumcision complications? Its true, but to find that figure, that is in their own government health systems stats, is not that easy. Here is a quick read about it. http://www.circinfo.org/USA_deaths.html

memewowme
memewowme

Man you Americans are idiots. The UK has a FREE National Health Service, and we don't have all these supposed diseases and infections that Americans claim we'll get from having NORMAL, HEALTHY PENISES.

SonnyVizzle
SonnyVizzle

Now hiring sadists!
Looking for obstetricians and gynecologists.
Duties include torturing newborn baby boys, coercing parents into signing circumcision forms, and breaking your oath to do no harm. Who cares about oaths when you've got money?

Send your resume and cover letter to:
We Love Mutilation
698 Kellogg's Way
Quack, Michigan 01888

Please help to spread the word!

Rob_L
Rob_L

I seriously can not believe this is considered journalism.

http://pediatrics.aappublications.org/content/early/2013/03/12/peds.2012-2896.full.pdf+html

This pretty much covers everything that is argued in favor of circumcision.  STI rates are pretty much equal in Europe and the US and in some instances we have more, circumcision is preventing nothing.  Don't forget to throw more of the AIDS myth out there.

http://www.amfar.org/about-hiv-and-aids/facts-and-stats/statistics--worldwide/

That's right, your chance of getting AIDS/HIV in America from a random sexual encounter and unprotected is less than getting struck by lightning.  69% of the worlds HIV cases are in subsaharan africa.

Stop trying to scare people into harming their children with bogus facts and bloating up fake stats about health care increases.  I can't believe you wasted anyone's time writing this trash of an article, or at least try writing one that required more than 5 minutes of pretend research.

As a man that lives everyday with a botched childhood circumcision from the 70's, I make sure everyone I know hears about how stupid this procedure is.  You aren't protecting your children from anything, it isn't any cleaner and baby girls get UTI's at a much higher rate than boys and they just give them antibiotics.

Estimated botched circumcisions range from 1-5% because it's truly unknown and generally not reported, because heaven forbid parents be informed about the complications of cosmetic procedure.

The reason the rates are dropping is because America is slowly waking up to the fact that 75% of the world leaves their children intact and without any problems.  Teach your children safe sex and not to go out and have sexual encounters with hookers and every promiscuous girl they find in a bar and if they do.. .wrap it up!  The chance of getting HIV/AIDS if you use a condom is so statistically small it's insane.  (from a random encounter) Even if you had sex directly with someone that had HIV and you were protected with a condom it's still very small.

Stop writing circumcision propaganda and  write some real news.

MarkDavenport
MarkDavenport

Much miss information in this article. I am in the UK were 99 percent of men are intact.No problems here, no more infections, no less hygiene. The forskin is a functional part of the body just like any other. This is a pure culture and bad science. Why don't we remove our ears at birth? We can live with out them and won't have to wash behind them.

FelixGarfield
FelixGarfield

@MarkDavenport  In Korea it is widely believed, even among doctors, that if you go to sleep with an electric fan switched on in your bedroom, you will die ("Fan Death"). Koreans are incredulous when you point out that no other country holds this wacky belief. Kinda reminds me of the American attitude to the prepuce ("Foreskin Death").

RoodToodDood
RoodToodDood

I was born in the mid-70's and thankfully was not cut, which is amazing since about 90% of males born then in the US were. My father refused to allow the procedure and basically had to remove me from the hospital to avoid it. I've never had an issue and cannot imagine why this barbarism is done outside of Judaism.

HayleyDawnKolarik
HayleyDawnKolarik

Infant Circumcision- why you think it's done: 

1. God wants it done. FALSE. "God made you perfect and in his image." God wouldn't give it to us if he didn't want us to have it. Disfiguring the body is prohibited in many religions including Judaism, Islam, and Christianity. 

2. Foreskin serves no purpose. FALSE. Millions of years of evolution have given foreskin to every man and most mammals. Evolution doesn't make mistakes like that.

3. Babies don't feel pain. ARE YOU RETARDED? Babies feel pain more intensely than adults. 

4. Babies won't remember. YES AND NO. 'Repressed memory' is a more appropriate description: and some do remember. 

5. Circumcision reduces risk of std's. FALSE It INCREASES the risk. Foreskin is a mucus membrane. Mucus TRAPS pathogens - it HELPS prevent disease. 

6. For hygiene. MAKES NO SENSE. How lazy can you possibly be? Taking care of a bloody wound in a diaper is easier? What else shall we amputate to stay clean - perhaps the labia? 

7. A deluge of other equally random and ridiculous excuses. -Circumcision has probably had more claims of benefit than any other medical procedure in history: that alone should tell you something. 

Infant Circumcision - Why it's actually done: 

1. Infants cannot defend themselves. - How many sane men would submit to cutting off healthy bits of themselves (some of the most sensitive bits no less..) for no benefit and without painkillers? 

2. The circumcision room is one of the most profitable areas in a ho$pital. 

3. Shame / Guilt / Maintaining an image / Stockholm syndrome. - It is easier to maintain a lie, than to admit having done harm to your child (or one of your parents having done harm to you).

CH
CH

LOL! skin 'er back and let mommy check before you go on your date. Knowing boy's and their irresponsibility with cleanliness, I can see the issues with being uncircumcised.  Of course all of you poster's know different, because if it didn't happen with your son in your home, it surely couldn't happen anywhere else. Your experts at Google and not medical professionals.... and I feel sure some of you will come back and claim you are, because you said so.

LauraIvansons
LauraIvansons

Your statistics are bunk! UNLESS men in America grow a different penis and foreskin than the rest of the world! Five intact boys in my home and a husband...never an infection, never a std, never a cancer...because all the statistics are LIES to make money. The rest of the world is mostly intact and it is a non-issue. The thing that MOST of these studies have in common are they are done by ignorant, American- trained doctors that have no education on the function of the foreskin in FIGHTING infection!

alexwpartridge
alexwpartridge

I would like to ask you, Alexandra Sifferlin, would you mind it if your clitoral hood was taken away? Because that is your prepuce (foreskin), and under US law you are protected from forced genital cutting of any sort. 

American men are not given the same protection over their own bodies. This is quite a shame. 

Circumcision is very invasive, excruciatingly painful, and unnecessary. This removal of 20,000+ nerve endings is also irreversible. Thankfully, my British father and wise American mother did not fall victim to this harsh American cultural "norm" and protected me and my brothers. We are all very grateful and have never had any problems with our whole penises.

Please, take the time to do research on the male anatomy and why everyone deserves his or her genitals how they are meant to be. I would not get circumcised for any amount of money.

CatherineSchau
CatherineSchau

Good lord,  not this stupidity again. Only in the anti-foreskin US is this considered a problem.   The low rates of circumcision in places like Finland and Denmark have not caused this "increase" in health care costs.  This is a horrible article full of misinformation.

Mommyof4WeeOnes
Mommyof4WeeOnes

Funny. Neither of my intact sons have incurred our family, or the state, any "extra" charges due to being intact. They are 3 and 5 years old. Neither has my whole husband, ever. He is 30. Curious...

How about these same researchers do a study on how much money the country would SAVE if we allowed girls to be circumcised legally? C'mon! You can't fight in favor of one cosmetic surgery only to turn your nose up to another... just sayin'.

MarkDavenport
MarkDavenport

If they are unable to clean their forskin. I would say they are pretty much paralysed and need a carer who will clean them. By the way stop insulting most of the un mutilated planet by suggesting they are un hygienic when they know dam well they are clean. Shall I suggest you are unhygienic because you did not have your finger nails removed at birth?

Rob_L
Rob_L

@DavidBusi @HayleyDawnKolarik @Mommyof4WeeOnes

http://www.amfar.org/about-hiv-and-aids/facts-and-stats/statistics--worldwide/

Except that the majority of circumcisions don't use anesthesia.  And as a man that was on the receiving end of a botched circumcision, I find it offensive that you call people against it Drama Queens.

Foreskins are neither dirty or irrelevant.  We get it , you were circumcised and you see fine, because you've never known better in your entire life.  Just keep preaching all the crap you hear because eventually this procedure will go by the wayside much like electroshock therapy and bleeding people back in the 1800's.

I can't believe you choose to be so offensive DavidBusi when 75% of the men in the world are intact and you and I are in fact not normal being circumcised.  Think about it, the U.S. isn't even remotely close to the world's best healtchare and yet you prance around all high and mighty on an internet forum like you know everything about intact penises of which you don't even have.  If there was true actual medical merit to circumcision, the rest of the world would follow suit to the U.S. like everything else, but they aren't.

DavidBusi
DavidBusi

@HayleyDawnKolarik @DavidBusi @Mommyof4WeeOnesThere is no brutality - no abuse - you know NOTHING of how circumcisions are done.  I can post a video of two circumcisions being done for the benefit of infants with pain control if you like to display your ignorance. of the matter.  There is no drama no emotion no dribble like the adjectives you use - just a nice clean circumcision a moment of effort for a life time of benefits.  No drama.  lower levels of disease, cleaner, lower maintenance, no women retching at the sight or smell of a smegma stinking penis - yes increased sexual options not decreased ones.  How do I know that it works just fine - I make love with my Wife EVERY single day and we are pretty darn good at it too.  My penis works just fine without a dirty foreskin.   Freaking drama Queen - Can you say you actually let him put this thing in your mouth?  

Allerchick
Allerchick

Very disappointed in this article, and in Time Magazine.  This is alarmist pseudoscience masquerading as real journalism; an editorial masquerading as a factual article.  Most men in the world are intact, and we don't see Scandinavia, Asia, Australia, Canada or South America rampant with HIV and STDs, and drowning in healthcare costs.  Do your research, Ms. Sifferlin.  If you are a serious journalist, don't just repeat what you hear from sources that clearly have a pro-circumcision bias.  

The HIV studies in Africa, in addition to being highly flawed, do not translate into a necessity for routine infant circumcision in the first world.  Further, a little girl has a 1 in 8 chance of developing breast cancer in her life.  If we remove the breast buds of all little girls as soon as they're born, we can decimate the incidence of breast cancer in our population.  Shall we do it?  Little girls get urinary tract infections at a higher rate than little boys.  If a little girl gets one, do we say, "What a shame we didn't remove her clitoral hood at birth..it's so dirty and nasty down there; no wonder she got an infection!"  No, we treat with antibiotics.  Seriously, circumcision is a solution looking for a problem.  Our bodies are fine just the way they are; no need to mess with what Mother Nature gave us.  This is a highly irresponsible article that benefits nobody but the doctors who make $$ performing circumcisions.

circesadreim
circesadreim

This is SUCH a load of rubbish. No such thing has happened to other developed countries that don't routinely mutilate their babies. Goodness, but the cutting culture is strong with some in the media here. Sad that they're rather spout off the same myths rather than do actual, you know, research ...

KellyChapmanBurns
KellyChapmanBurns

So... can anyone just write anything and it's ok? You are TIME magaine... what I thought was a well respected, reputable, and truth delivering source. GUESS NOT.

I'm confused about something... well, everything, because this was just a bunch of nonsense trying to scare people into cosmetic surgery, but whatever. insurance typically doesn't cover unneccessary crap, so... hello? That's why they are no longer convering genital cutting. There is a reason it was made illegal for girl in 1997, but you know... they're obviously more important than boys.

If I  were to get circ'd and have my clitoral hood removed, would that lessen my chances or ovarian cancer? um. no. So how does foreskin amputation reduce the risk of prostate cancer?

I had a uti once. Man, if only my parents had "ordered" genital cutting, maybe that could have been prevented.

You know what I learned when I was informed of sex? SAFE SEX helps prevent STD's...not genital cutting. You are nuts. get a clue.

JamesLoewen
JamesLoewen

Scare mongering headline: "If Circumcision Rates Keep Falling, Health Costs and Infections Will Spike." What  utter NONSENSE! Most of the world's men (80%) have their whole penis (complete with a moveable foreskin, as nature intended) and guess what? They are perfectly healthy! The whole penises of the world have NOT caused "health cost and infections to spike." Utter nonsense! And propaganda for the sick circumcision industry in the USA.


The damages caused to children and the adults they become when circumcisions are botched means in some cases totally ruined lives, and deaths.


Your pathetic headline pales when you start looking at the casualties, the untold damages of circumcision forced upon children.


Why don't you look into this issue Alexandra Sifferlin and report on it in a way that wold actually protect children instead of subjecting them to an imposed, sexually mutilating surgery which resultants in loss of normal, healthy sexual anatomy. Why don't you go back to your editor and pitch a story that actually does some good?



JeffGraw
JeffGraw

Oh, I forgot one last point. The HIV and SDT epidemics in the circumcision-happy US are almost entirely due to anal sex. Look it up on the CDC webpage and you will see that for men you are over 80 times more likely to get infected with HIV if you have anal sex, and there are many studies showing that circumcision does NOT protect gay men from HIV. 

Journalism is dead.