Circumcision Procedure - Cost

Circumcision is amongst the 40 most frequently performed surgical procedures, occurring more commonly than tooth extraction [35].

In the USA cost per newborn is typically $165 [510]. Postneonatal circumcision, however, is 10 times as expensive [510].

In Australia, in the year to Feb 2004, 16,311 neonatal circumcisions were performed in Australia at a cost to Medicare of A$623,080. Interestingly, 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 scheduled fee for a neonatal circumcision in 2004 was A$38.20 (~US$26) [38]. 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.

In 2007 the scheduled fee was A$42.00, with a benefit of $35.70 [362]. For age 0.5-10 y the scheduled fee was $97.65 and benefit $83.05. For over age 10 these were $135.20 and $114.95 (if done by a general practitioner) and $167.65 and $142.55 (if done by a specialist). 

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 it because of the low return relative to other procedures.

In the USA, a neonatal circumcision will generally cost US$89-204, 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 [347]. From 1999 to 2007, of the 52 states in the USA, 16 have ceased to allow Medicaid payments for circumcisions other than those needed to treat a medical condition [389]. This short-sighted policy, which would save money in the short term (but not the long term), has followed intense lobbying by anti-circ organizations.

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.