Position Statement on Access to Specialty Care and Direct Access to Dermatologic Care

Position Statement on Access to Specialty Care and Direct Access to Dermatologic Care

(Approved by the Board of Directors March 1997)

The American Academy of Dermatology believes that all Americans should have the freedom to choose their own physicians and the health insurance coverage that best meets their needs. It is this freedom of choice, coupled with the availability of specialty medicine, that has distinguished the American health care system. Specialized training and care have produced numerous medical advances that have resulted in life-saving and life-enhancing treatments.

For most Americans, the health care system provides prompt and direct access to medical and surgical specialists. However, managed care now covers a major portion of the health insurance market, and the vast majority of those plans restrict access to specialty care and patient choice.

The Academy believes that health insurance plans should not set barriers or impediments to appropriate specialized medical services. Direct access to specialty care is essential for patients in emergency and non-emergency situations and for patients with chronic and temporary conditions. Health insurance plans must provide a full range of specialists for their enrollees. Specialty care must be available for the full duration of the illness and not be limited by time or the number of physician visits. Every health insurance plan should cover a patients care by the physician of his or her choice whether in-network or out-of-network. Likewise, the Academy supports all patients having direct access to dermatologic care delivered by dermatologists. Patients in managed care settings should be able to visit a dermatologist without first receiving a referral from a gatekeeper or primary care physician because patients are able to visually determine a problem with regard to the skin. Any patient with a chronic skin condition should be able to elect a dermatologist as their primary physician within a plan.

Direct access to dermatologists is the easiest and most cost-effective method of providing quality dermatologic services in managed care settings. Studies have indicated that dermatologists are more cost-effective and provide higher quality of care to patients with skin diseases. Improper diagnosis of skin diseases results in: additional costs from unnecessary diagnostic tests, office visits or treatments; possible complications from unnecessary treatments; and prolonged patient suffering. Patients experience loss of income and productivity from missed work due to misdiagnosis. There may even be increased morbidity and potential mortality from delayed diagnosis and treatment. It is critical, therefore, that every patient in a managed care setting have direct access to dermatologic services delivered by a dermatologist.