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 unnecessary, harmful, or injurious medical procedures encourages the performance of such services, simply so the attending physician can collect a fee. Kamanzi et al. (2023) reported:

Private insurance plans reimburse significantly more than public plans for newborn circumcision. For non-newborn circumcision, private plans reimburse more than public but the coverage is more restricted, with a smaller differential between newborn and non-newborn circumcision. This coverage and reimbursement structure may indirectly encourage newborn circumcision for privately insured boys and non-newborn circumcision for publicly insured boys.[1]

Third-party payment for injurious medically-unnecessary, non-therapeutic child circumcision in the United States keeps the incidence of non-therapeutic circumcision of children far higher than any other industrial nation.

Cessation of third-party payment is likely to reduce the incidence of harmful circumcision in the United States. Hill (2021) estimated that the overall incidence of circumcision in Mississppi, where Medicaid does not provide third-party payment for non-therapeutic circumcision, is about 20 percent.[2] The only party to benefit from such third-party payments is the receiving physician and/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. The intent of the statement was to spur the demand for circumcision to aid the circumcision industry. It was published in 2012 but received overwheming, unrelenting criticism from many critics because of its evident omissions of facts. The 2012 AAP statement was an acute embarrassment to the AAP so it was not re-affirmed and allowed to expire in accordance with long-standing 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 and does not recommend circumcision.

The certain harm of circumcision

Circumcision is a cutting operation to amputate a functional part of the penis. Newborn boys cannot receive general anesthesia, so every circumcision of newbory boys causes great pain. Analgesia is offered to sell circumcision by making parents feel better, but does little for the infant boy. There is also extreme physical and psychic trauma caused by the loss of a body part. The foreskin normally has protective, immunological, sensory, and sexual functions, which are destroyed with the amputation.

All circumcisions excise the ridged band, which is the source of much sexual sensation, resulting in a permanent life-time loss of sensation.

The loss of the immunological and protective functions makes penile health issues more likely. In comparison, due to the open wounds and raw bleeding flesh in a diaper, the circumcised penis needs much more care after circumcision. The surgically externalized glans is dirty rather then clean because of constant exposure to dirt, abrasion, pathogens, and contaminants.[3] Circumcised boys are also found to be more likely to develop balanitis, meatitis, coronal adhesions, and meatal stenosis.[4]

The excision of skin by circumcision makes painful erections more likely. Circumcised males may experience tight and/or painful erections when there is insufficient residual shaft skin to permit full expansion and extension of the shaft of the penis during erection.

Maguire & Parkes (1998) stress the need to grieve loss of body parts and functions,[5] and there are many other psychological issues.

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 ritual circumcision, who published an opinion-based paper in 1914 in the Journal of the American Medical Association to defend ritual cirumcision that falsely claimed health benefits of circumcision.[6] The purpose of the paper was to defend ritual circumcision, which was under attack for transmitting tuberculosis to newborn infants.[7] 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.[8] The unspoken and unwritten 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 existing 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 coverage of infant circumcision is provided.[9] United States Medicaid is one of the largest third-party payers for medically-unnecessary, non-therapeutic circumcision.[10]

The advent of HIV provided an additional excuse to provide free circumcision.

Cost of complications

Moreover, the foreskin has immunological and protective functions that are ablated by circumcision, therefore foreskinned males enjoy better health.[11] [4] [12]

Circumcisions have 47 cLasses of complications, which must be treated at additional expense in addition to the expense of the original amputation.

Many circumcisions are unsatisfactory and require revision by a pediatric urologist. It is said that pediatric urologists spend twenty percent of their time in repairing damages caused by circumcision.

U. S. government providers of circumcision

The United States has numerous medical programs through which free harmful and unnecessary non-therapeutic circumcisions are provided. They include:

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.[13] Dave et al. (2003) reported a prevalence of circumcision of 15.8% in the United Kingdom.[14]
  • Afsari et al. (2002) reported New Zealand Health does not support circumcision without a medical indication.[15] 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.[16]
  • The Australian Pædiatric Association resolved in 1971 "that newborn male infants should not, as a routine, be circumcised."[17] 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.[18] Circumcision Information Australia (2020) called non-therapeutic circumcision in Australia "now pretty much a thing of the past."[19]
  • 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.[20] Third-party payment for non-therapeutic circumcision is not available in Canada.

Video

Circumcision lawsuit on circumcision

See also

External links

References

  1. Jump up REFjournal Kamanzi SN, Walton RF, Rosoklija I, Corona LE, Holt JL, Johnson EK. Differential Insurance Plan Coverage and Surgeon Reimbursement of Pediatric Circumcision at an Urban, Midwestern Hospital. Urology. September 2023; 179: 143-50. PMID. DOI. Retrieved 31 January 2025.
  2. Jump up 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].
  3. Jump up REFjournal Van Howe RS. Variability in penile appearance and penile findings: a prospective study. Br J Urol. 2003; 80: 776-782. DOI. Retrieved 20 October 2019.
  4. Jump up to: a b REFjournal Van Howe RS. Incidence of meatal stenosis following neonatal circumcision in a primary care setting. Clin Pediatr (Phila). January 2006; 45(1): 49-54. PMID. DOI. Retrieved 31 January 2025.
  5. Jump up REFjournal Maguire P, Parkes CM. Coping With Loss: Surgery and Loss of Body Parts. BMJ. 4 April 1998; 317(7137): 1086-8. PMID. PMC. DOI. Retrieved 31 January 2025.
  6. Jump up REFjournal Wolbarst AL. Universal Circumcision as a Sanitary Measure. JAMA. 10 January 1914; 62(2): 92-97. Retrieved 19 January 2025.
  7. Jump up REFjournal Holt LE. Tuberculosis acquired through ritual circumcision. JAMA. 12 July 1913; 61(2): 99-102. Retrieved 19 January 2025.
  8. Jump up REFconference Skeldon, Sean: The Medicalization and Resultant Decline of Circumcision in Canada, Calgary, AB. Health Sciences Centre. (March 2008) Retrieved 19 January 2025.
  9. Jump up REFjournal Craig A, Bollinger D. Of Waste and Want: A Nationwide Survey of Medicaid Funding for Medically Unnecessary, Non-Therapeutic Circumcision PDF. Academia. 2005; : 1-14. Retrieved 1 February 2025.
  10. Jump up 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.
  11. Jump up REFjournal Gairdner DMT. The fate of the foreskin: a study of circumcision. British Medical Journal. 1949; 2(4642): 1433-7. PMID. PMC. DOI. Retrieved 28 October 2019.
  12. Jump up REFjournal Fendereski K, Horns JJ, Driggs N, Lau G, Shaeffer AJ. Comparing Penile Problems in Circumcised vs. Uncircumcised Boys: Insights From a Large Commercial Claims Database With a Focus on Provider Type Performing Circumcision. J Pediatr Surg. November 2024; 59(11): [161614]. PMID. PMC. DOI. Retrieved 3 January 2025.
  13. Jump up REFweb (20 November 2018). Circumcision in boys, National Health Service. Retrieved 17 January 2025.
  14. Jump up 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.
  15. Jump up 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.
  16. Jump up REFnews Bone, Alistair (17 November 2001)."The First Cut", The Listener. Retrieved 24 January 2020.
  17. Jump up REFjournal Bellmaine SP. Circumcision. Medical Journal of Australia. 22 May 1971; 1: 1148. Retrieved 18 January 2025.
  18. Jump up 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.
  19. Jump up REFweb Circumcision in Australia. Retrieved 18 January 2025.
  20. Jump up REFdocument Skeldon, Sean: The Medicalization and Resultant Decline of Circumcision in Canada PDF, University of Calgary. (March 2008). Retrieved 18 January 2025.