title: Projected financial impact of noncoverage of elective circumcision by Louisiana medicaid in boys 0 to 5 years old.
abstract: OBJECTIVE
  Several states, including Louisiana since 2005, no longer cover elective circumcision under Medicaid programs. The recent AAP (American Academy of Pediatrics) policy statement recognizes the medical benefits of circumcision and recommends the removal of financial barriers to this procedure. Cost savings are a factor in the limitation of circumcision coverage, although to our knowledge the actual cost savings to Medicaid programs have not been reported. We analyzed the number of circumcisions performed before and after the policy change to determine an accurate cost of such procedures and whether the increased procedure expense mitigates the initial savings.
  
  
  METHODS
  We analyzed the number of neonatal and nonneonatal circumcisions in boys 0 to 5 years old to determine trends during the selected period. A cost model for each procedure was created. Neonatal procedure cost was based on professional fees. Nonneonatal procedure cost was based on professional (surgeon and anesthesia) plus facility fees. The number and cost of procedures were compared before (2002 to 2004) and after (2006 to 2010) the policy change. Linear regression was used to predict future costs.
  
  
  RESULTS
  The average annual number and expense of neonatal circumcisions were significantly decreased after the policy change. There was no significant decrease in nonneonatal procedures and expense. Cost per procedure ranged from $88.34 for neonatal to $486.76 for nonneonatal circumcision. Secondary to the increasing number of more costly nonneonatal procedures, the annual expense was predicted to exceed pre-policy levels by 2015.
  
  
  CONCLUSIONS
  The number of nonneonatal circumcisions is increasing and such procedures place a higher financial burden on the health care system. As a result, the financial benefits of noncoverage of elective circumcision are decreasing.
authors: Department of Urology, Louisiana State University, Children's Hospital New Orleans, New Orleans, Louisiana.
authors: Joseph
authors: J
authors: Ortenberg
authors: Christopher C
authors: CC
authors: Roth
mesh_terms: D002675:Child, Preschool; D002944:Circumcision, Male / Q000191:economics* / Q000379:methods; D017046:Cost Savings; D005544:Forecasting / Q000379:methods*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D019458:Insurance Coverage / Q000706:statistics & numerical data*; D008145:Louisiana; D008297:Male; D008484:Medicaid / Q000191:economics*; D012189:Retrospective Studies; D014481:United States
keywords: DHH; Department of Health and Hospitals; Medicaid; child; circumcision; infant; male; penis; preschool