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Dermatologist access limited for Medicaid-insured children with eczema

Medicaid-insured children with eczema had limited access to dermatologists, according to recent study results.

Researchers in St. Louis conducted “secret-shopper” scripted telephone calls to 723 Medicaid health plan-listed dermatology providers, which represented 13 diverse metropolitan health care markets. Portraying a parent request for a new appointment for a child with eczema, paired calls — differing by Medicaid vs. private insurance — were made to each office on the same day.

Four hundred seventy-one (65%) dermatologists were included in the final analysis. New Medicaid-insured pediatric patients with eczema were refused by 44% of the dermatologists. One hundred five (22%) dermatologists did not accept children with either type of insurance. Overall market size-weighted average acceptance rate was 19% for all dermatologists (6% to 64% by market) accepting new Medicaid-insured children. No significant difference in average wait time for an appointment between insurance types was observed (mean of 28 days for Medicaid vs. 22 days for privately insured patient; P=.055), and only confirmed apointments were used for calculating average waits.

“Our findings supported previous reports of limited Medicaid patient access to ambulatory care … demonstrating worse access for children than for adults,” the researchers concluded. “Access to care is likely to play a major role in achieving control over chronic diseases such as eczema. … Our findings suggest that additional providers alone may not increase access to care for Medicaid-insured patients, as increased dermatologist density did not correlate with increased Medicaid acceptance.

“If patients rely on Medicaid provider lists to find a physician, they may learn … that only a fraction of Medicaid-contracted dermatologists actually accept new patients and that there are often additional requirements to schedule an appointment.”