x Abu Dhabi, UAESaturday 20 January 2018

Circumcision costs burden the poor, says Grand Mufti

Most health insurance schemes in the country do not cover circumcision for newborns, which can be a pricey procedure.

DUBAI // The Grand Mufti of Dubai has criticised the high cost of newborn circumcision, saying that insurance companies must meet the needs of their clients and that people should not be burdened by a procedure considered a duty in Islam.

The average cost for neonatal circumcision in private hospitals, excluding clinics, is about Dh2,000. In the US, it is US$291 (Dh1,069).

Dr Ahmed bin Abdul Aziz Al Haddad, Grand Mufti and head of the Fatwa Department at the Dubai Fatwa Centre, said these rates could be exploiting patients. "People with limited means must not be taken advantage of," he said. "The operation is easy and does not require much effort and should not cost a lot of money.

"It was and is still practiced by the hallaq [barbers] in villages and rural areas and it costs nothing. Those who need insurance coverage and private clinic services are expatriates and the needy - those who are not very fortunate - so they must not be saddled with extra charges."

Muslim parents say that male circumcision should be one of the basic medical needs covered by insurance companies, given the context of living in a Muslim country.

Salama Mohammed, 29, an accountant from Egypt, said she had to pay Dh2,200 for her son's circumcision after her insurance company refused to accept the claim.

"They informed me that my son did not require it as a medical necessity, and is therefore not covered," she said. "I just think that having to pay for the procedure in a Muslim country is taking advantage of the situation."

Ms Mohammed said she went to Latifa Hospital, a public hospital run by the Dubai Health Authority, where she was told she needed a referral.

"I also heard that the private clinics are cleaner and do a better job," she said. "And I didn't want to place my son in the wrong hands, even if it meant paying a higher price."

Ms Mohammed did not reveal the name of her insurance company, for fear of repercussions from her employer.

There are approximately 16 births per 1,000 residents each year in the UAE. While there are no clear statistics on what percentage are Muslim, figures from the Pew Forum on Religion and Public Life show that 76 per cent of the population is Muslim.

Most parents delivering at private hospitals choose to have their newborn sons circumcised. Of the 1,041 male births last year at The City Hospital in Dubai, more than 60 per cent underwent the procedure.

The hospital charges approximately Dh2,100 for circumcision, including the doctor consultation.

Dr Patrick Balquet, a specialist paediatric surgeon at the The City Hospital, said few insurance companies cover newborn circumcision.

At American Hospital Dubai, the procedure costs Dh2,200 and can reach Dh12,000 if the child is more than six weeks old and requires inpatient care.

Major insurance companies and their regulators say circumcision is not part of basic coverage, but can be added in premium packages.

"Routine circumcision is a predictable cost as most members will elect to circumcise their children for different reasons including religion and health," said Sven Rohte, commercial chief officer at Daman, the national health insurance company. "Health insurance in general covers risks of unexpected medical costs and with circumcision, that is not the case."

Newly converted Muslims are an exception to the rule.

"The law in Abu Dhabi stipulates that a newly converted male Muslim with a health insurance policy issued in Abu Dhabi is eligible for claims against circumcision costs if he has declared his conversion to Islam in an Abu Dhabi court," Mr Rohte said.

Thiqa, the national Emirati health insurance service managed by Daman, covers circumcision for all UAE nationals. In Abu Dhabi, where health insurance is required by law for all workers, circumcision coverage is not required.

In other Muslim countries, including Qatar and Bahrain, the procedure is covered for nationals but is considered an added benefit for expatriates. Like Dubai, both countries have yet to adopt a mandatory insurance scheme for expatriate workers.

In Saudi Arabia, however, where insurance is obligatory for all the country's residents regardless of nationality, the procedure is covered for all.

Mahmoud Abduraddaha, section head of government prices and product benefits at the Health Authority-Abu Dhabi (Haad), which regulates the emirate's health policies, said the emirate's health-insurance law was initially intended to serve workers who were not "fortunate enough" to afford basic health care.

"We wanted to make sure that every individual has basic minimum health coverage to make sure he or she does not suffer or die unnecessarily," he said. "It had to be at a low cost to the employer, yet provides the employee with basic coverage. A majority of our target were workers, mainly adults in nature. Therefore, this was not considered a must-have service."

Mr Abduraddaha said the authority chose to make an exception for newly converted Muslims, who are normally adults.

"We also wanted to leave room for insurance companies to compete," he said. "This is why we give encouragement but we don't mandate [the procedure's coverage]."

He said Haad would consider amending the law if it saw a clear demand from the market.

Dr Al Haddad encouraged such a step. "Cooperative health insurance is good and it should meet all the needs required by the insured," he said. "It was originally put in place to help people in such pressing cases."

The Ministry of Health and the Dubai Health Authority declined to comment.