Variation in Dermatologist Visits by Sociodemographic Characteristics

Published in: Journal of the American Academy of DermatologyVolume 76, Issue 5, May 2017 [Epub January 2017], Pages 918-924. doi:10.1016/j.jaad.2016.10.045

Posted on RAND.org on April 26, 2017

by Andrew W. Mulcahy, Ateev Mehrotra, Karen E. Edison, Lori Uscher-Pines

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Research Questions

  1. How often do Medicaid enrollees visit dermatologists in comparison to patients who are uninsured or have private insurance?
  2. Are Medicaid patients more likely to receive care for skin-related conditions from primary care physicians or dermatologists?

Background

Access to dermatologists is an ongoing concern for Medicaid enrollees. Understanding current use is a key step toward designing and implementing policies to improve access.

Objective

We sought to quantify how often Medicaid enrollees visit dermatologists and receive treatment for skin-related conditions compared with patients with other coverage or without health insurance.

Methods

We conducted a retrospective cross-sectional analysis of multiyear federal survey data (Medical Expenditure Panel Survey). The sample included Medical Expenditure Panel Survey respondents younger than 65 years from 2008 to 2012.

Results

In unadjusted comparisons, we found that 1.4% of Medicaid enrollees had an ambulatory visit to a dermatologist annually, compared with 1.2% of uninsured individuals and 5.5% of individuals with private coverage. In adjusted models, we found that health insurance source, age, sex, race/ethnicity, and geography are associated with the likelihood of having visits to a dermatologist. Compared with individuals with private coverage, Medicaid enrollees are less likely to receive a diagnosis for a skin condition by any provider and are less than half as likely to have skin-related diagnoses made by dermatologists.

Limitations

We have relatively few Medical Expenditure Panel Survey respondents for a subset of specific diagnoses.

Conclusions

Our findings emphasize the need for efforts to reduce disparities in access to dermatologists.

Key Findings

  • Medicaid enrollees are less likely to receive care from a dermatologist than people with private insurance, signaling that Medicaid patients face barriers to accessing these specialists.
  • Differences in receipt of care among Medicaid enrollees and privately insured people were not associated with sociodemographics or illness burden.
  • Rates of dermatologist use were similar among Medicaid enrollees and people with no health insurance.
  • Skin-related condition diagnosis among Medicaid enrollees was more likely to come from primary care doctors than dermatologists.

Recommendation

  • To increase Medicaid enrollees' access to dermatologists, states could require managed care plans to maintain more extensive networks of dermatologists, increase dermatologists' payment rates, or introduce teledermatology to enable distant consultations.

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