Circumcisions and cost cutting

[palliddreamer]

Since we’re talking about cutting costs, let’s talk about procedures. Giving Americans more input and more stake in their health care, making them pay for some things directly will likely go a long way towards reducing costs and reducing needless or frivolous testing. North Carolina Medicaid, as well as some other private insurance companies, has

Comments

[mikejj]

Really? Even with data showing a decreased risk of HIV transmission?

[palliddreamer]

I agree that HIV transmission could be a valid reason to continue the practice, however I think there are much better ways to protect people. Namely education and condoms. The UK and rest of Europe seem to handle it ok without resorting to surgery.

Do you do them in the NICU? Some of our neos did them but most didn't and I wasn't sure if there's more exposure in a neo fellowship.

[mikejj]

My story is similar to yours- I never learned in residency/fellowship, although I would imagine that varies based on the program. The OBs at my place do them, and I have no compelling reason to learn.

I'm not convinced the HIV argument is a compelling reason for doing them either, at least in this country.

[lilostitch]

Once it's botched, I would think the repair would no lot be "elective", and then would be covered by insurance anyway, right?
Are you saying that no coverage for circs = less circs = less repairs required? Or are you saying that no coverage for circs = repairs shouldn't be covered either?

I see the point on the former, but not so much on the latter.

[palliddreamer]

I was assuming any botched ones would be covered, either by malpractice or just plain insurance. I'm actually not certain how it works in terms of payment now but I would bet on fewer 'fixes' with fewer procedures.

Who knows? Maybe people feel strongly enough about doing it that people will cough up the cash. I'm not one who thinks of it as genital mutilation I just think it's unnecessary and could save money.

[iliana_sedai]

I agree with you! That being said, neither Husband (English from UK) nor I (Chinese American) are from cultures where circumcision is considered desirable. Totally a strange American obsession, especially since the US is supposed to be a mostly-WASP country!

I too have seen more than my fair share of botched circs, which only reinforces my personal belief that 1) OBs should not be doing circs, 2) OBs should not be doing any kind of surgery, 3) OBs should not practice any sort of medicine. *cough* (Ha, I've been afraid of OBs since my third year of medical school -- a more stubbornly self-important yet woefully ignorant group of physicians I have never seen... but that is just my prejudice....), and 4) there is no way I would subject any son of mine to either an OB or a circumcision (even if the two are mutually exclusive)!

[sweet_tea79]

You know, I've never understood why OBs do circs. Let's take a profession whose entire field of study is the female reproductive system, and have them do procedures on the male system. Does. Not. Compute.

Then again, I'm a peds girl who doesn't want to learn how to do circs so this arrangement works well for me.

[palliddreamer]

This comment made me laugh out loud, especially since I just came off a night in the nursery. Most of it was spent in the OR for 'failure to progress.' I mean, the lawyers are to blame for a lot of it, but still, these guys just don't get physiology.

[grimalkinrn]

I agree with this. I've never been a huge fan of circumcision, and after caring for a 77 year old patient whose botched circ + unrepaired hypospadias (sic?) nearly caused some mild post op edema to become severe and cause all sorts of problems... I'm even less of a fan. While it may decrease the risk of HIV, an open, educated environment also cuts down the risk of HIV.

I agree with you on this one.

[sweet_tea79]

Yeah, I think there are better ways of preventing the spread of HIV than circs. I imagine that education has a lower complication rate for one thing...

[palliddreamer]

Yup, plus there's no data on an epidemiological scale that says wide spread circs decrease the prevalence of HIV. I'd hate to make a national policy without some sort of data suggesting a large scale benefit. Until then, condoms it is...

[grimalkinrn]

Also, there are plenty of circumsized males who do get HIV. You wouldn't tell your daughter not to use condoms because she had the HPV vaccine, right? There's still plenty of nasty out there. Circumcision is not a valid plan for STD prevention. I completely agree with you that circumcision should be an out of pocket expense.

[litlebanana]

I'm Jewish and I agree with you (although we probably won't be doing a circ if we have a boy). There's not any huge health benefit and it's basically a personal choice. When Jews do it in a ceremony, they have to pay for the whole thing anyway and it's not covered by insurance. I just had no idea that it would save any kind of appreciable amount of money.

Then again, maybe there's some sort of slippery slope argument, where if the insurance companies don't have to cover that, they don't have to cover other things, like pain procedures since that's a personal choice too. Or repairs of disfiguring cancer surgeries.

[sweet_tea79]

Back in my year of surgery, I did a lot of plastics cross cover (which was great when I was on trauma and had to consult both hand and plastic surgery. I just consulted...myself. Anyhow, I also did several surgeries when I was on the oncology service that were joint PRS/oncology procedures. Turns out that a lot of those oncology repairs are covered by insurance and Medicaid (in NC, where circ aren't covered). They may not be covered in full in all cases, but they were covered. Breast augmentation following mastectomy (even prophylactic mastectomy), scar revision (especially if there was functional impairment), and the like were usually partially covered. And if they weren't covered by insurance, NC Medicaid had special programs to help pay. It was one of the things I really liked about oncologic surgery.