RAND Corporation, Arlington, Virginia.
Harvard Medical School, Boston, Massachusetts.
J Am Acad Dermatol. 2017 May;76(5):918-924. doi: 10.1016/j.jaad.2016.10.045. Epub 2017 Jan 6.
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.
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.
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.
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.
We have relatively few Medical Expenditure Panel Survey respondents for a subset of specific diagnoses.
Our findings emphasize the need for efforts to reduce disparities in access to dermatologists.
医疗补助计划的参保者一直难以获得皮肤科医生的服务。了解当前的就诊情况是制定和实施旨在改善医疗服务可及性政策的关键步骤。
我们旨在定量评估与拥有其他保险或没有医疗保险的患者相比，医疗补助计划的参保者看皮肤科医生和接受皮肤相关疾病治疗的频率。
我们对联邦多年调查数据（医疗支出面板调查）进行了回顾性横断面分析。该样本包括 2008 年至 2012 年期间年龄小于 65 岁的医疗支出面板调查受访者。
在未调整的比较中，我们发现，每年有 1.4%的医疗补助计划参保者会去看皮肤科医生，而没有医疗保险的个体比例为 1.2%，私人保险的个体比例为 5.5%。在调整后的模型中，我们发现医疗保险来源、年龄、性别、种族/族裔和地理位置与看皮肤科医生的可能性相关。与拥有私人保险的个体相比，医疗补助计划的参保者更不可能从任何提供者那里获得皮肤疾病的诊断，而由皮肤科医生做出的皮肤相关诊断的可能性不到其一半。
我们对特定诊断子集的医疗支出面板调查受访者相对较少。
我们的研究结果强调了需要努力减少在获得皮肤科医生服务方面的差异。
