The effect of health care coverage on circumcision rates among newborns

Social and personal biases are thought to have a role in the decision to circumcise newborns. However, economic factors such as the type of health care coverage may determine which parents are offered circumcision during the newborn period. Therefore, we examined the rates of newborn circumcision among patients with and without insurance at a midwestern community hospital and tertiary care center.

A retrospective analysis of all patients undergoing circumcision at 2 different labor and delivery facilities between January 1997 and December 2001 was performed. Female gender, prematurity and all congenital anomalies comprised exclusion criteria. Circumcision rates were stratified by health care coverage and race. To assess characteristics of patients who did not undergo circumcision during the newborn period the indications for circumcision and insurance status were examined at a children's hospital.

Health care coverage differed significantly between the 2 labor and delivery facilities. Medicaid or uninsured patients comprised approximately 72% of the population at the tertiary care facility and slightly less than 10% of the total deliveries at the community hospital. Despite the difference in health care coverage status, there was no statistically significant difference between the rates of circumcision among newborns. The circumcision rates were 81% (4,021 of 4,992 cases) and 82% (8,059 of 9,859) at the community and tertiary care facilities respectively. Similarly, there was no difference between circumcision rates when stratified by health care status or race. At the children's hospital there were 2 distinct populations seeking circumcision. Of Medicaid patients 87% younger than 3 years sought circumcision because they were denied circumcision during the newborn period. In contrast, adoption was cited 90% of the time as the reason for seeking circumcision in the privately insured patients.

Although health care coverage may influence the indications for circumcision in older children, health care coverage does not appear to influence newborn circumcision rates in the Midwest.