Medicaid vs Private Insurance Disparities in Melanoma Screening

Among patients on Medicaid in California, family medicine and especially dermatology practices had low acceptance rates of this insurance, and access to melanoma screening was fraught with delays in family practices when compared with patients on private insurance, according to study findings published in the Journal of the American Academy of Dermatology International. 

California, the most populous US state, diagnoses more than 9000 melanomas annually. Researchers sought to compare insurance acceptance rates in several regions in California of Medicaid (public insurance) and Anthem Blue Cross (private insurance) in dermatology and family medicine practices and the wait times for an appointment for someone with a changing skin lesion.

To accomplish this, they conducted a cross-sectional audit “mystery client” study that included 62 dermatology practices in the San Francisco Bay Area (San Francisco, Alameda, and Contra Costa counties) and 54 practices in the Central Valley (Fresno, San Joaquin, Sacramento, Shasta, and Butte counties) accounting for nearly all dermatology practices in both areas, and 50 family medicine practices  in the SF Bay Area and 50 FMPs in the Central Valley, more than half of all FMPs in those areas from  June 2017 to March 2019.

Each practice was called (using a script) to request an appointment for a worrisome, changing, pigmented skin lesion. The caller made clear the type of insurance before appointments were given. Subsequently, the same caller would make another call to the same practice and provide the “other” insurance plan. The order of insurance plans reported was randomly chosen. Callers noted insurance acceptance, and, wait times for “the next available in-person visit.”

Medicaid insurance acceptance was low in the SF Bay Area and the Central Valley for dermatology (11.3% and 13%, respectively), and, for family medicine practices (36% and 28%, respectively), compared with about 90% or better for Anthem Blue Cross acceptance in both practices in both regions. “In both regions, [family medicine practices] wait times were 2.4- to 3.2-fold longer for public vs private insurance; there were little differences in wait times for the 2 insurance types in dermatology practices, in both regions.”

Study limitations included the small sample geographic area in California, and the study did not assess other factors affecting care access. Researchers commented, “We found that the number of physicians available to see Medicaid-insured patients with a concerning pigmented lesion in the SF Bay Area and the Central Valley was markedly below the recommended optimal national levels, decreased 10-fold for dermatologists and 5-fold for family practitioners.”

Researchers concluded that types of insurance and business practices affect the availability of patients with possible melanomas to be screened, and thus affect potential outcomes. They said, “access to screening for melanoma is decreased for patients in the Central Valley compared with their counterparts in the more urban SF Bay Area due to several factors: greater numbers of Medicaid-insured patients in the Central Valley, lower density of dermatologists and family practitioners accepting Medicaid in that region, and increased wait times at family medicine offices.” They urge the support of, “timely, equitable access to dermatologic care.”

Reference

Cortez JL, Fadadu RP, Konda S, Grimes B, Wei ML. Disparities in access for melanoma screening by region, specialty, and insurance: A cross-sectional audit study. JAAD Int. Published online March 29, 2022. doi:10.1016/j.jdin.2022.02.008