In conducting the study, researchers posed as parents trying to schedule an appointment for their child with eczema. Unlike children with private insurance, Medicaid-insured children often had to provide a written referral or identification numbers before an appointment could be scheduled.
Eczema most often affects children. The condition causes itchy, red, cracked and dry skin. Eczema can also disrupt sleep and negatively affect behavior and quality of life.
"The purpose of this study was to compare access to dermatologists for new pediatric patients with eczema insured by Medicaid versus private plans," study first author Dr. Sofia Chaudhry, an assistant professor of dermatology at Saint Louis University and a practicing dermatologist, said in a school news release.
The researchers said the lack of access to a dermatologist is particularly worrisome since eczema affects 20 percent of children in the United States. Complicating matters, health care reform will expand the number of children insured by Medicaid from about 32 million to roughly 50 million.
"This is a complex problem and a major health disparity in our country," lead study investigator Dr. Elaine Siegfried, a professor of pediatrics at Saint Louis University, said in the news release. "Thirty percent of all children seen in primary care offices have a skin problem. It's an everyday issue."
The study revealed that only 19 percent of all dermatologists in 13 U.S. cities accept Medicaid. Of the nearly 500 specialists who were listed as Medicaid-participating providers by Medicaid insurance plans, 44 percent refused to schedule an appointment with a new Medicaid-insured child.
Chaudhry explained why the situation needs to change.
"Since [eczema] can be a chronic debilitating disease, it's important for these children to be able to see a dermatologist," she said. "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."
The researchers suggested possible reasons dermatologists may be reluctant to see Medicaid-insured patients, including:
- Concerns about additional administrative paperwork
- Convoluted or delayed payments
- A high no-show rate of patients
- Extra time required to address patients with complex social issues
- Possible medical-legal liabilities associated with these patients
The study was published online and in the May print issue of the Journal of the American Academy of Dermatology.