Third-party payment in the United States

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Third-party payment is the term used to refer to payments for medical services and procedures by a third-party, usually public or private medical or health insurance company or government program.

Third-party payment for non-therapeutic or unnecessary medical procedures encourages the performance of such services, simply so the attending physician can collect a fee.

Third-party payment for injurious medically-unnecessary, non-therapeutic child circumcision in the United States keeps the incidence of non-therapeutic circumcision of children higher than any other industrial nation.[1] The only party to benefit from such third-party payments is the receiving physician, or hospital.

The physicians that most commonly perform non-therapeutic infant circumcisions are obstetricians, pediatricians, and family doctors. They formed an agreement in 2007 to produce a new statement with the AAP as the lead. It was published in 2012 but was poorly received because of its evident omissions of facts. The AAP statement was not re-affirmed is accordance with AAP policy, so it expired on August 31, 2017. The AAP has not replaced the failed 2012 policy statement so it now has no official policy regarding male circumcision.

U.S. Government policy on circumcision

The government policy regarding male circumcision seems to have been formulated by the military services at the time of World War I. It appears to have been based on the 1914 article of Abraham L. Wolbarst, M.D., an ardent Jewish promoter of circumcision, who published an opinion-based paper in 1914 in the Journal of the American Medical Association that promoted claimed health benefits of circumcision.[2] The purpose of the paper was to defend ritual circumcision, which was under attack for transmitting tuberculosis to newborn infants.[3] The article seems to have influenced the medical officers of the United States military service who were seeking to keep military personnel free of venereal disease.[4] The unspoken official U.S. Government policy seems to be that it is clear every male needs a circumcision, so support for free circumcision is provided without any questions being asked. This had been the policy of the military services since about 1917 when the United States intervened in the World War. When the Congress created the Medicare and Medicaid programs in 1965, the every male needs a circumcision policy was adopted. About 45 percent of births in the United States are covered by Medicaid and in most states free harmful and unnecessary coverage of infant circumcisions are provided.

United States Medicaid is one of the largest third-party payers for medically-unnecessary, non-therapeutic circumcision.[5]

The American Academy of Pediatrics created its failed 2012 policy statement (expired in 2017) specifically to preserve and protect third party payment to medical doctors.

Third-party payment policy in English-speaking nations

Most English-speaking nations do not provide financial support for harmful, non-therapeutic circumcision:

  • The United Kingdom created the National Health Service (NHS) in 1948. The NHS is not an insurance programme; it actually is a healthcare institution that provides a full range of medical services. It did not then and does not now provide non-therapeutic circumcision.[6] Dave et al. (2003) reported a prevalence of circumcision of 15.8% in the United Kingdom.[7]
  • Afsari et al. (2002) reported New Zealand Health does not support circumcision without a medical indication.[8] The New Zealand Medical Association estimated in 2001 that about one percent of Caucasian boys in New Zealand were being circumcised, but nearly 100 percent of Tongan, Samoan, and Jewish boys are being circumcised.[9]
  • The Australian Pædiatric Association resolved in 1971 "that newborn male infants should not, as a routine, be circumcised."[10] That remains the position of medical science today. Public hospitals of the several states of Australia do not permit the performance of non-therapeutic circumcision.[11] Circumcision Information Australia (2020) called non-therapeutic circumcision in Australia "now pretty much a thing of the past."[12]
  • Canada has fourteen health insurance plans (HIP). One by one, the HIPs each made a decision to delete non-therapeutic circumcision from the schedule of covered procedures. The HIP for Manitoba was the last to discontinue coverage for non-therapeutic circumcision. It stopped in 2006.[4] Third-party payment for non-therapeutic circumcision is not available in Canada.

See also

External links

References

  1. ↑ REFweb Hill, George (April 2021). Circumcision Incidence in Mississippi Icons-mini-file pdf.svg, Research Gate. Retrieved 14 April 2021.
    Quote: Depending on the accuracy of the assumptions, these figures may indicate that cessation of Medicaid payments and other third-party payments is a highly effective way to reduce the incidence of trauma of harmful non-therapeutic circumcision and to improve male health and well-being. (1) (PDF) Circumcision Incidence in Mississippi. Available from: https://www.researchgate.net/publication/350799429_Circumcision_Incidence_in_Mississippi [accessed Apr 14 2021].
  2. ↑ REFjournal Wolbarst AL. Universal Circumcision as a Sanitary Measure. JAMA. 10 January 1914; 62(2): 92-97. Retrieved 19 January 2025.
  3. ↑ REFjournal Holt LE. Tuberculosis acquired through ritual circumcision. JAMA. 12 July 1913; 61(2): 99-102. Retrieved 19 January 2025.
  4. ↑ a b REFconference Skeldon, Sean: The Medicalization and Resultant Decline of Circumcision in Canada, Calgary, AB. Health Sciences Centre. (March 2008) Retrieved 19 January 2025. Cite error: Invalid <ref> tag; name "skeldon2008" defined multiple times with different content
  5. ↑ REFjournal Adler PW. Is it lawful to use Medicaid to pay for circumcision?. Journal of Law and Medicine. 2011; 19: 335-353. Retrieved 8 November 2019.
  6. ↑ REFweb (20 November 2018). Circumcision in boys, National Health Service. Retrieved 17 January 2025.
  7. ↑ REFjournal Dave SS, Fenton KA, Mercer CH, Erens B, Wellings K, Johnson AM. Male circumcision in Britain: findings from a national probability sample survey. Sex Trans Infect. December 2003; 79(6): 499-500. PMID. PMC. DOI. Retrieved 18 January 2025.
  8. ↑ REFjournal Afsari, Mahnaz, Beasley, Spencer W., Moate, Kiki, Hecket, Karen. Attitudes of Pacific parents to circumcision of boys. Pac Health Dialog. March 2002; 9(1): 29-31. PMID. Retrieved 18 January 2025.
  9. ↑ REFnews Bone, Alistair (17 November 2001)."The First Cut", The Listener. Retrieved 24 January 2020.
  10. ↑ REFjournal Bellmaine SP. Circumcision. Medical Journal of Australia. 22 May 1971; 1: 1148. Retrieved 18 January 2025.
  11. ↑ REFjournal Na AF, Tanny SPT, Hutson JM. Circumcision: Is it worth it for 21st-century Australian boys?. J Paediatr Child Health. June 2015; 51(6): 580-3. PMID. DOI. Retrieved 18 January 2025.
    Quote: Most Australian states withdrew circumcision from the range of free services provided in public hospitals through Medicare funding system.
  12. ↑ REFweb Circumcision in Australia. Retrieved 18 January 2025.
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