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%.
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.”
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.