MD-PhD Candidate University of Virginia Charlottesville, Virginia
Abstract: Clinicians routinely offer and perform newborn circumcision despite persistent debate about its risk-benefit ratio. One consequence of this clinical and ethical debate is differential state-level policies regarding government-subsidized reimbursement for circumcision performed in the newborn period. This variability in healthcare policy has led to an increase in patients receiving more circumcisions in the non-neonatal period, constituting a higher risk and higher cost procedure. Patients and families who rely on publicly available insurance rather than private payer policies are disproportionately affected, raising pressing questions concerning government subsidy of newborn circumcision. Specifically, should a procedure that poses certain ethical and physical infringements on neonatal patients be uniformly covered by state-sponsored Medicaid insurance plans? And if so, by what justification? While further research of medical risks and benefits should precede the routine reimbursement of the procedure, data regarding its safety and efficacy could catalyze its broader coverage. Conversely, cessation of circumcision coverage by state-specific Medicaid programs would disincentivize the procedure in the newborn period and may disproportionately harm those patients and families who rely on Medicaid coverage for newborn healthcare expenses. Here, I will detail historical examples of state-sponsored insurance coverage for newborn circumcision, the clinical outcomes that ensued in response to policy change, and describe implications for public health and policy. Ultimately, it is the moral, ethical, and professional duty of pediatric healthcare providers to protect newborns and children from infringements on their autonomy, preserving their right to an open future while also mitigating the exacerbation of current newborn healthcare disparities.
Keywords: newborn circumcision, pediatric ethics, social determinants of health
Learning Objectives:
After participating in this conference, attendees should be able to:
Describe the role of insurance status and its contribution to disparate health outcomes in patients who undergo routine newborn circumcision.
Consider and evaluate proposed modifications of public policy approaches to government-subsidized insurance coverage for newborn circumcision and their potential clinical impact on neonatal patient care.
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