Circumcision Procedure - Cost
Circumcision is amongst the 40 most frequently performed surgical procedures, occurring more commonly than tooth extraction [Australia's, 1992].
In the USA cost per newborn is typically $165 [Schoen et al., 2006]. Post-neonatal circumcision, however, is approx. 10 times more expensive [Schoen et al., 2006]. The total cost of newborn circumcisions in the USA is estimated as US$150270 million.
In Australia, in the year to Feb 2004, 16,311 neonatal circumcisions were performed at a cost to Medicare of A$623,080. Interestingly, as an important historical anecdote, back in 1985 the Federal Minister for Health removed the rebate for newborn circumcision from the Medical Benefits Schedule in response to the (now outmoded) 1983 recommendations of the National Health & Medical Research Council (NHMRC) of Australia. It was then quickly restored after a public outcry. The NHMRC currently has no policy statement on circumcision.
The scheduled fee for a neonatal circumcision in Australia in 2004 was A$38.20 (~US$36) [Australian, 2004b]. The overall cost to Medicare for circumcisions in the year to Feb 2004 was thus A$623,080 + $275,210 + ($298,880 or $369,086) = $928,170 to $998,375.
The scheduled fee for a neonatal circumcision in Australia in 2004 was A$38.20 (~US$26) [Australian, 2004b]. The overall cost to Medicare for circumcisions in the year to Feb 2004 was thus A$623,080 + $275,210 + ($298,880 or $369,086) = $928,170-998,375.
In 2007 the scheduled fee in Australia was A$42.00, with a benefit of A$35.70 [Medicare, 2007b]. For circumcision of those aged 0.510 years the scheduled fee was A$97.65 and benefit A$83.05. For circumcisions in those over age 10 these figures were A$135.20 and A$114.95, respectively, (if done by a general practitioner) and A$167.65 and A$142.55 (if done by a specialist).
In late 2009, the scheduled fee for a male under 6 months of age was A$43.95, with the Medicare benefit being A$37.40 (85%) or A$33.00 (75%) [Government, 2009] (http://www9.health.gov.au/mbs/search.cfm?q=30653-30660&sopt=I). For 0.5-10 years the scheduled fee was A$102.20 and benefit A$86.90 (85%) or A$76.65 (75%). The general practitioner fee for males 10 and over was A$141.50 and the benefit A$120.30 (85%) or A$106.15 (75%). For a specialist the scheduled fee was A$175.45 and benefit A$149.15 (85%) or A$131.60 (75%).
Many doctors consider that the scheduled fee and thus benefit in Australia should be higher, as such a low rebate has the potential to cause some doctors to discourage circumcision because of the low return relative to other procedures.
In the USA, a neonatal circumcision will generally cost US$89204, being cheaper in the mid-west and more expensive on the east coast. A review in 1995 found that 61% of infant circumcisions were paid for by private insurance, 36% by Medicaid, and 3% were paid for by the parents [Mansfield et al., 1995]. From 1999 to 2007, of the 52 states in the USA, 16 had ceased to allow Medicaid payments for circumcisions other than for those needed to treat a medical condition [National, 2006b]. As a result, circumcision rate, especially amongst the poor, has gone down in those states, and will have a devastating effect on public health [Leibowitz et al., 2009; Morris et al., 2009]. Such short-sighted policy, which would save money in the short term (but not the long term), has followed intense lobbying by anti-circumcision organizations. The devastating impact the latter extremists having on gullible politicians is to be deplored.
Similar nonsense has seen governments in the southern states of Australia in 2006 and 2007 exclude circumcisions, except for “medical need”, in the public hospital system, classing them as “social” or “cosmetic” procedures along with breast implants, tattoo removal, liposuction and reversal of sterilization. The Ministers for Health suggest circumcision be sourced in the private sector, failing to recognize any of the health benefits. Quite surprising is that the governments that made these decisions were of the Labor (socialist) party, meaning that the poor in society, who are usually more likely to be protected by Labor party policies and who rely on the public hospital system, are the ones now most adversely affected.
Clearly common sense and the application of evidence-based medicine to circumcision policy is needed in the public health system.