Cutting Out Circumcision Could Cost Billions: Study
Declines in infant male circumcision in the United States
could add more than $4.4 billion in avoidable health care costs for sexually
transmitted infections, experts warn in a new report.
In a paper in the Archives of Pediatrics & Adolescent
Medicine, a team of health economists and disease experts at Johns Hopkins cite
the declining rates of U.S. infant male circumcision — from 79 percent in the
1970s to approximately 55 percent today — as responsible for billions of
dollars spent in the U.S. on preventable infections.
The decline in circumcision rates has already cost the
nation an estimated $2 billion, the researchers say, and if rates decrease to
the 10 percent levels seen in Europe, this could mean an additional $4.4
billion for the nation.
The cost of treating sexually transmitted infections in
both males and females that could be prevented with circumcision accounts for
most of this total. Circumcision removes the foreskin at the end of the penis,
which would otherwise potentially serve as a haven for bacteria and viruses
that can cause diseases including HIV, herpes, genital warts, bacterial
infections and urinary tract infections. Research has also suggested that
circumcision can cut risk of penile and prostate cancers in men, as well as
cervical cancer risk in their female partners.
There are many possible reasons for the decline in
circumcisions. Many families may be averse to circumcision for personal
reasons, object to a procedure that was imposed in the past because of
religious beliefs. Arleen Leibowitz and
Katherine Desmond of UCLA’s department of public policy write in a comment
following the paper that “low income families’ decisions to circumcise their
newborn boys are quite responsive to whether or not Medicaid pays for the
procedure.”
Dr. Aaron Tobian, the principal study investigator,
agreed that Medicaid funding cuts are partially to blame. Such cuts have
already caused many states to stop paying for infant male circumcisions.
California, North Dakota, Oregon, Mississippi, Nevada and Washington stopped
funding before 1999, and in the last decade, Missouri, Arizona, North Carolina,
Montana, Utah, Floria, Maine, Louisiana, Idaho, and Minnesota all stopped
Medicaid funding for circumcision. The
most recent states to ban funding were Colorado and South Carolina, in 2011.
“The financial and health consequences of these decisions
are becoming worse over time, especially if more states continue on this
ill-fated path,” said Tobian, who is an assistant professor of pathology at the
Johns Hopkins Center for Global Health. “State governments need to start
recognizing the medical benefits as well as the cost savings from providing
insurance coverage for infant male circumcision.”
Other experts agree that this finding should have policy
implications.
“States’ efforts to reduce current costs by eliminating
Medicaid coverage for male circumcision are penny wise and pound foolish,”
write Leibowitz and Desmond. “Investing today in a relatively low-cost
procedure will avert greater future treatment costs for cancer, HIV, and other
sexually transmitted infections.”
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