Managed care and the treatment of skin diseases. Dermatologists do it less often

Data from the 1985 and 1992 National Ambulatory Medical Care Survey and the 1992 National Health Interview Study were used to determine changes in total visit rates for patients with common skin disease and the proportion of all visits to dermatologists that were provided as part of managed care plans. The setting was a sample of office-based practitioners across the United States. The patients were from a sample of 106,200 office visits in 1985 and 1992 and 128,412 persons who provided data for a population-based interview study. The main outcome measure were number of visits per year and percentage increase from 1985 to 1992 by reason for visit, specialty of physician consulted, and type of insurance expected to pay for the visit and the percentage of persons with specific demographic characteristics who have managed care coverage. The changing source of payment for all office visits and visits for skins diseases as a result of managed care is assessed.

From 1985 to 1992, the percentage of office visits with managed care coverage more than doubled. The proportion of managed care patients with skin complaints cared for by dermatologists declined. The age-adjusted rates of visits for adults with managed care insurance to dermatologists are less than one third the rate for other adults without prepaid care.

Managed care is rapidly growing as the source of payment for the office-based care of skin complaints. The role of dermatologists in providing this care is diminishing.