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 inde mnity insurance to see a dermatologist for skin problems, and it was p redicted that this would result in a slowing in the demand for dermato logist services. To examine whether the changing healthcare environmen t has resulted in fewer visits to dermatologists, we used National Amb ulatory Medical Care Survey data from the years 1990-1992 to examine u tilization of dermatologist services over a period in which managed ca re grew by 32%, Patients with HMO/prepaid insurance were less likely t o have their skin care provided by dermatologists than patients with c ommercial insurance (Blue Cross/Blue Shield and other commercial carri ers) or Medicare. A reduction in the number of visits to dermatologist s was observed among patients with HMO/prepaid insurance despite the g rowth in HMO/prepaid insurance as a form of payment; when all payers w ere considered, however, the number of visits to dermatologists increa sed from the 1989 level, reaching a plateau in 1992. The number of vis its for skin disease to all physicians increased from 56.5 million to 63.5 million, whereas the proportion of this care delivered by dermato logists decreased from 39.6% to 37.9%, The overall increase in visits for skin conditions tempered the reduction in demand for dermatology s ervices expected with the growing transition to managed care.