Lower utilization of dermatologists in managed care: despite growth in managed care, visits to dermatologists did not decrease: an analysis of National Ambulatory Medical Care Survey data, 1990-1992.

Growth of managed care and the decline of direct access are two of the major issues confronting dermatology. Previous study has demonstrated that patients in managed care are less likely than patients with indemnity insurance to see a dermatologist for skin problems, and it was predicted that this would result in a slowing in the demand for dermatologist services. To examine whether the changing health-care environment has resulted in fewer visits to dermatologists, we used National Ambulatory Medical Care Survey data from the years 1990-1992 to examine utilization of dermatologist services over a period in which managed care grew by 32%. Patients with HMO/prepaid insurance were less likely to have their skin care provided by dermatologists than patients with commercial insurance (Blue Cross/Blue Shield and other commercial carriers) or Medicare. A reduction in the number of visits to dermatologists was observed among patients with HMO/prepaid insurance despite the growth in HMO/prepaid insurance as a form of payment; when all payors were considered, however, the number of visits to dermatologists increased from the 1989 level, reaching a plateau in 1992. The number of visits for skin disease to all physicians increased from 56.5 million to 63.5 million, whereas the proportion of this care delivered by dermatologists decreased from 39.6% to 37.9%. The overall increase in visits for skin conditions tempered the reduction in demand for dermatology services expected with the growing transition to managed care.