title: Coverage of newborn and adult male circumcision varies among public and private US payers despite health benefits.
abstract: Studies have shown that male circumcision greatly reduces the risk for heterosexual transmission of HIV, other sexually transmitted infections, infant urinary tract infections, penile cancer, and other adverse health outcomes. Given recent data regarding these health benefits and the cost-effectiveness of newborn male circumcision, national policy makers are developing new recommendations regarding circumcision for newborn, adolescent, and adult males. To investigate the implications, this study assessed insurance coverage and reimbursement for routine newborn and adult male circumcision in private and public health plans in 2009. We found that coverage varies across private and public payers. Private insurance provides far broader coverage than state Medicaid programs for routine newborn male circumcision. Specifically, Medicaid programs in seventeen states do not cover it, even though low-income populations have a higher risk of HIV and other sexually transmitted diseases compared to higher-income groups. For adult male circumcision, coverage is generally sparse across public and private plans. Presentation of evidence-based recommendations--for example, from the Centers for Disease Control and Prevention--may be necessary if coverage for newborn and adult male circumcision is to be expanded.
authors.affiliation: Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, Michigan, USA. saclark@med.umich.edu
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Clark
authors.forename: Peter H
authors.initials: PH
authors.lastname: Kilmarx
authors.forename: Katrina
authors.initials: K
authors.lastname: Kretsinger
mesh_terms: D000293:Adolescent; D000328:Adult; D002487:Centers for Disease Control and Prevention, U.S.; D002944:Circumcision, Male / Q000191:economics*; D003430:Cross-Sectional Studies; D019317:Evidence-Based Medicine; D006291:Health Policy; D054624:Health Status Disparities; D006801:Humans; D007231:Infant, Newborn; D019458:Insurance Coverage / Q000706:statistics & numerical data*; D008297:Male; D008484:Medicaid / Q000191:economics*; D012051:Reimbursement Mechanisms; D012749:Sexually Transmitted Diseases / Q000517:prevention & control; D014481:United States