Advertisement

Variation in dermatologist visits by sociodemographic characteristics

Published:January 06, 2017DOI:https://doi.org/10.1016/j.jaad.2016.10.045

      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 words

      Abbreviations used:

      CI (confidence interval), MEPS (Medical Expenditure Panel Survey), OR (odds ratio)
      To read this article in full you will need to make a payment
      AAD Member Login
      AAD Members, full access to the journal is a member benefit. Use your society credentials to access all journal content and features

      Purchase one-time access:

      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

      1. CDC. National Ambulatory Medicare Care Survey Factsheet: Dermatology. Available at: https://www.cdc.gov/nchs/data/ahcd/namcs_2010_factsheet_dermatology.pdf. Accessed October 20, 2016.

      2. Armstrong A, Kwong M, Ledo L. Tele-dermatology in Medi-Cal: findings from the field and challenges for the future. Available at: http://cchpca.org/sites/default/files/resources/Tele-Dermatology%20in%20Medi-Cal%20Issue%20Brief%2010-11.pdf. Accessed October 20, 2016.

        • Eide M.
        • Weinstock M.
        • Clark M.
        The association of physician-specialty density and melanoma prognosis in the United States, 1988 to 1993.
        J Am Acad Dermatol. 2009; 60: 51-58
        • Coates S.J.
        • Kvedar J.
        • Granstein R.D.
        Teledermatology: from historical perspective to emerging techniques of the modern era: part II: emerging technologies in teledermatology, limitations and future directions.
        J Am Acad Dermatol. 2015; 72 (quiz 587-588): 577-586
        • Chaudhry S.B.
        • Armbrecht E.S.
        • Shin Y.
        • et al.
        Pediatric access to dermatologists: Medicaid versus private insurance.
        J Am Acad Dermatol. 2013; 68: 738-748
        • Ahn C.S.
        • Allen M.M.
        • Davis S.A.
        • Huang K.E.
        • Fleischer Jr., A.B.
        • Feldman S.R.
        The National Ambulatory Medical Care Survey: a resource for understanding the outpatient dermatology treatment.
        J Dermatolog Treat. 2014; 25: 453-458
      3. AHRQ. Medical Expenditure Panel Survey Data. Available at: http://www.ahrq.gov/research/data/meps/index.html. Accessed October 20, 2016.

        • Landis E.T.
        • Davis S.A.
        • Taheri A.
        • Feldman S.R.
        Top dermatologic diagnoses by age.
        Dermatol Online J. 2014; 20: 22368
        • Stern R.S.
        Dermatologists and office-based care of dermatologic disease in the 21st century.
        J Investig Dermatol Symp Proc. 2004; 9: 126-130
        • Alghothani L.
        • Jacks S.K.
        • Vander Horst A.
        • Zirwas M.J.
        Disparities in access to dermatologic care according to insurance type.
        Arch Dermatol. 2012; 148: 956-957
        • Resneck Jr., J.
        • Pletcher M.J.
        • Lozano N.
        Medicare, Medicaid, and access to dermatologists: the effect of patient insurance on appointment access and wait times.
        J Am Acad Dermatol. 2004; 50: 85-92
      4. Zuckerman S, Goin D. How much will Medicaid physician fees for primary care rise in 2013? Evidence from a 2012 survey of Medicaid physician fees. Available at: https://kaiserfamilyfoundation.files.wordpress.com/2013/01/8398.pdf. Accessed October 20, 2016.

        • Long S.K.
        Physicians may need more than higher reimbursements to expand Medicaid participation: findings from Washington State.
        Health Aff (Millwood). 2013; 32: 1560-1567
        • Uscher-Pines L.
        • Malsberger R.
        • Burgette L.
        • Mulcahy A.
        • Mehrotra A.
        Effect of teledermatology on access to dermatology care among Medicaid enrollees.
        JAMA Dermatol. 2016; 152: 905-912