"This is a complex problem and a major health disparity in our country," said Elaine Siegfried, M.D., professor of pediatrics at SLU and the principal investigator of the study. "Thirty percent of all children seen in primary care offices have a skin problem. It's an everyday issue."
SLU researchers found that only 19 percent of all dermatologists in 13 metropolitan areas across the United States accept Medicaid-insured children. Of the 471 dermatologists who were listed as Medicaid-participating providers by Medicaid insurance plans, 44 percent declined to schedule a new Medicaid-insured child.
"The purpose of this study was to compare access to dermatologists for new pediatric patients with eczema insured by Medicaid verus private plans," said Sofia Chaudhry, M.D., assistant professor of dermatology at SLU and the first author of the study, which was published online in the Journal of American Academy of Dermatology
In this secret-shopper survey, researchers posed as parents and called dermatology offices across the country to request an appointment for their child with eczema. Even when a dermatologist was accepting new Medicaid-insured children, these children were more often required to provide a written referral and/or identification numbers before an appointment date could be offered, in comparison to privately-insured children.
Eczema mainly affects children and is often a chronic condition in which the skin becomes itchy, reddened, cracked and dry. In addition to the physical effects, eczema also impacts the quality of life, causing emotional, behavioral and sleep disturbances.
"Since it can be a chronic debilitating disease, it's important for these children to be able to see a dermatologist," said Chaudhry, who is also a SLUCare dermatologist. "Improved access to dermatologists is important for treating eczema in order to enhance the well-being of affected children and to minimize the expensive cost of emergency care," Chaudhry added.About 32 million children are insured with Medicaid health insurance plans, and that number is likely to expand by 16 to 18 million with the new health care reform.
Chaudhry and other researchers identified several possible factors that may discourage dermatologists from seeing a Medicaid-insured patient. These include a physician's concern of additional administrative paperwork, convoluted or delayed payments, a high no-show rate of patients, extra time required to address patients with complex social issues and possible medical-legal liabilities associated with them.