Impact of Health Insurance Type on Trends in Newborn Circumcision, United States, 2000 to 2010

Abstract

Objectives: We explored how changes in insurance coverage contributed to recent nationwide decreases in newborn circumcision.

Methods: Hospital discharge data from the 2000-2010 Nationwide Inpatient Sample were analyzed to assess trends in circumcision incidence among male newborn birth hospitalizations covered by private insurance or Medicaid. We examined the impact of insurance coverage on circumcision incidence.

Results: Overall, circumcision incidence decreased significantly from 61.3% in 2000 to 56.9% in 2010 in unadjusted analyses (P for trend = .008), but not in analyses adjusted for insurance status (P for trend = .46) and other predictors (P for trend = .55). Significant decreases were observed only in the South, where adjusted analyses revealed decreases in circumcision overall (P for trend = .007) and among hospitalizations with Medicaid (P for trend = .005) but not those with private insurance (P for trend = .13). Newborn male birth hospitalizations covered by Medicaid increased from 36.0% (2000) to 50.1% (2010; P for trend < .001), suggesting 390,000 additional circumcisions might have occurred nationwide had insurance coverage remained constant.

Conclusions: Shifts in insurance coverage, particularly toward Medicaid, likely contributed to decreases in newborn circumcision nationwide and in the South. Barriers to the availability of circumcision should be revisited, particularly for families who desire but have less financial access to the procedure.

FIGURE 1—

Medicaid coverage of newborn circumcision procedures by state: United States.

FIGURE 2—

Incidence of newborn circumcision among male newborn hospitalizations by type of health insurance in (a) the United States, (b) Northeast, (c) Midwest, (d) South, and (e) West: Healthcare Cost and Utilization Project Nationwide Inpatient Sample, 2000–2010.

FIGURE 3—

Increase in proportion of male newborn hospitalizations covered by Medicaid in relation to the observed and expected number of circumcision events nationwide: United States, 2000–2010.