Circumcisions in older boys and related costs skyrocket in Florida, study shows

November 14, 2013

Circumcisions in Florida boys over the age of 1 have increased dramatically in recent years, doubling costs to the state, a study by University of Florida Health surgical researchers shows.

Dr. Saleem Islam, an associate professor in the College of Medicine department of surgery's division of pediatric surgery, said he and his study collaborators believe the state's decision to terminate Medicaid funding for routine circumcisions in babies under 1 month old has led to the increase in circumcisions for older boys. The study was published in the September issue of the journal The American Surgeon.

Islam said families should decide for themselves whether to have their sons circumcised, but emphasized that in the newborn period is preferable for several important reasons.

"The benefits are that the child does not have to undergo general anesthesia, there is much less cost to public monies, it's safer for the kids to get it done and that's the right age, as well," he said.

Because newborns require only local anesthesia for a circumcision, newborn circumcisions are safer and much less expensive. They also have a lower risk of complications. Circumcising older boys requires general anesthesia to ensure the patient remains still during the procedure.

Florida was one of numerous states to stop Medicaid coverage for routine newborn circumcisions after a 1999 report from the American Academy of Pediatrics said the procedure may not be medically necessary.

Islam explained that circumcisions can increase hygiene in the penis, and some uncircumcised males suffer from recurrent urinary tract or penile infections. Some parents will choose circumcision because of these potential problems or for religious or cultural reasons. Islam said he does not take a firm stance either for or against circumcision, but prefers for parents to decide.

The state cut off Medicaid coverage for the procedure in 2001. Many insurance companies also stopped paying for newborn circumcisions after the report. Funding remains available for circumcisions in older males when the procedure is deemed medically necessary, such as when repeated infections occur.

In 2012, the American Academy of Pediatrics reversed its stance on routine newborn circumcisions, citing research indicating they may help protect against HIV and provide other benefits.

UF Health researchers' study of data from 2003 to 2008 shows publicly funded circumcisions increased at a rate more than six times greater than the increase in privately funded circumcisions. They also cost approximately $111.8 million over the five-year time period, an amount estimated by medical facility charges during the study period. Fees for health care providers were excluded from the study, meaning the actual amount paid for the procedures was probably greater. The study results also showed that circumcisions in boys over age 1 were more common each year than those performed on newborns.

By 2008, yearly Medicaid costs for circumcision in boys through age 17 reached $33.6 million, compared with $14.9 million in 2003. Meanwhile, private charges for circumcisions in Florida rose from $9.3 million to $14.1 million. Circumcisions in 2008 accounted for 30 percent of the estimated total costs for the procedure during the five-year window.

Islam said the increase in circumcisions among older boys likely stemmed from parents, supported by referring physicians, who had hygiene or medical concerns, but were unable or unwilling to pay for the procedure during the newborn period. UF Health pediatric surgeons noted they had talked with some of their own patients' parents about the decision to have an older boy circumcised and found that many parents would have opted for newborn circumcision if public funding were available.

The American Academy of Pediatrics' new stance on the issue may lead states and to restore funding for the procedure in newborns, a change Islam would welcome.

"It would make a lot of sense to offer it (newborn circumcision) to families who otherwise perhaps may not be able to afford it," he said, "and then say, 'Here, we are offering it to you when your child is a newborn. You have a choice to make here. If you choose to get it done now, there are a lot of benefits over having it done later.'"

Explore further: Declining rates of US infant male circumcision could add billions to health care costs

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5 / 5 (1) Nov 14, 2013
The best time to circumcise is never, and there are very good reasons not to circumcise newborns.

How come Europe, South America and Australasia don't see problems with not circumcising? Almost no-one gets circumcised there unless their parents are Jewish or Muslim, but almost no-one gets circumcised later either. The rate of medically-required circumcision is down to 1 in 140 in the UK and dropping, and lower than 1 in 1000 in some Scandinavian countries. Compare that to a 5-10% revision rate for neonatal circumcision in the USA (a "revision" is effectively a second circumcision).

It's not like it can't wait. The USA (at 55% and dropping) and Israel are the only two countries in the world where more than half of baby boys are circumcised. Other countries circumcise, but not till anywhere from the age of seven to adolescence.

In Scotland, you have to wait till a baby is six months old before getting a circumcision on the NHS, and in Switzerland, they make you wait two years.
5 / 5 (1) Nov 14, 2013
Circumcision: the non consensual mutilation of working reproductive tissue.
Why is that they do not promote female circumcision? why THEY are treated with compassion? Male hating culture? I bet females without clitoris are so much more productive at work. Since they like to justify their insane violence against boys...
not rated yet Nov 14, 2013
Another predictable new pro non therapeutic circumcision of male minors study and article. There are many errors but the most serious one is to say "a 1999 report from the American Academy of Pediatrics said the procedure may not be medically necessary." In fact, neither the 1999 nor the 2012 AAP statement says the procedure is necessary. That is of course logical since there's no necessity to remove a normal, healthy and functional body part. In fact it's contraindicated and unethical (when done to an unconsenting patient).
not rated yet Nov 14, 2013
You didn't mention that the rest of the world does not force genital mutilation on their sons, whether insurance pays for it or not.

The rest of the world has medical treatments for the few boys who develop inflammations, etc. Surgery is not a treatment, it is just another source of profit for a medical system that costs us four times more than any other nation and gives us worse outcomes. Too many interventions for too much profit gives bad medical results.

Every reason the medical racket ever used to scare parents into doing this to their son was a lie. They won't even acknowledge the psychological harm they do to us.

Why do doctors/hospitals fight so hard to mutilate babies and little boys? Because grown men wouldn't let them!

Religious freedom does not allow you to force your perversion on others.

How can genital mutilation be unspeakable for one gender and so necessary for the other?

Why are Europeans puzzled that American men prefer oral sex?
3 / 5 (2) Nov 14, 2013
I wonder what this costs?

"Two infants in the last three months in New York City's ultra-Orthodox Jewish community have been infected with herpes following a ritual circumcision, according to the health department. The boys were not identified.

"In the most controversial part of this version of the Jewish ritual, known as metzitzah b'peh, the practitioner, or mohel, places his mouth around the baby's penis to suck the blood to "cleanse" the wound.

"One of the two infected babies developed a fever and lesion on its scrotum seven days after the circumcision, and tests for HSV-1 were positive, according to the health department.

"Since 2000, there have been 13 cases of herpes associated with the ritual, including two deaths and two other babies with brain damage."

-Gods will. Priceless.
3 / 5 (2) Nov 14, 2013
"Religious freedom does not allow you to force your perversion on others."

-Of course it does. Did the babies with herpes have a choice?

"How can genital mutilation be unspeakable for one gender and so necessary for the other?"

-Well its not is it?

"The practice of cutting into female organs is prevalent in a number of countries in Africa, the Middle East and south Asia as well as among migrant families in Europe and the United States. Female Genital Mutilation/Cutting (FGM/C) is usually carried out between infancy and 15 years of age to keep women "pure," marriageable and unable to enjoy sex. Consequences include severe bleeding, childbirth complications, and of course pain.

"91 percent of Egyptian females aged 15-49 years old may have been circumcised, most of them when they were young and could not protect themselves."

-They didnt have a choice either. Did they?
not rated yet Nov 15, 2013
It seems pretty obvious that families and doctors are colluding to trump up supposed justifications for a circumcision that medicaid would not pay for.

In places where parents know not to fiddle with the normal genitals (for example with ill-advised retracting of the prepuce) the medical need for a circumcision occurs in fewer than 1 in 10,000 males.

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