Andrew Mulcahy1, Ateev Mehrotra2, Karen Edison3, Lori Uscher-Pines4. 1. RAND Corporation, Arlington, Virginia. Electronic address: amulcahy@rand.org. 2. Harvard Medical School, Boston, Massachusetts. 3. University of Missouri Health System, Columbia, Missouri. 4. RAND Corporation, Arlington, Virginia.
Abstract
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.
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.