Barriers to healthcare access in pediatric dermatology: A systematic review

Abstract

Barriers to healthcare access (BtHA) are factors that prevent a patient or patient population from obtaining necessary medical care. 1 Past research has revealed that BtHA are multifactorial, and in some instances, may manifest from or propagate an existing health inequity. BtHA can be categorized as systemic, sociocultural, or individual barriers. 1,2 Systemic barriers include those that arise from legal frameworks, governmental policies or institutional policies and practices. 2 For example, requiring a fixed address for identification and health insurance can act as a systemic barrier against homeless patients. Meanwhile, sociocultural barriers include factors arising from a group characteristic, such as a race/ethnicity, religion, or locality. 2 Common barriers that fall within this category stem from communication difficulties or a lack of comfort in seeking care. Individual barriers refer to characteristics unique to a patient that negatively impacts their access to health care. 1,2 These can include being overburdened with responsibilities, having previously experienced discrimination in health care or having medical and/or mental health conditions that make healthcare access challenging.Within the last two decades, a growing number of studies have examined BtHA in the context of medical specialties. These studies have confirmed that BtHA such as geography, wait times, insurance, healthcare knowledge, language, and race/ethnicity apply beyond primary care specialties. Dermatology is not immune to these issues with some studies identifying unique health inequities and barriers.For example, some studies have found an underrepresentation in the number of healthcare providers of ethnic minorities and limited institutional training and exposure to skin of color. 3,4 Improvement to either domain may lead to increased patient satisfaction and outcomes for African American patients. 4,5 In contrast to adult dermatology, little research has been conducted on BtHA within the context of pediatric dermatology. Pediatric patients likely have additional unique barriers due to factors such as their reliance on caregivers and the local availability of pediatric dermatologists. This systematic review

Comparison of Work Relative Value Units for Outpatient Pediatric and Adult Dermatology Encounters

“…7 Patient enrollment in Medicaid has been associated with limited access to health care and pediatric dermatology clinic no-shows. 8,9 Discrepancies in actual reimbursement and access to care in dermatology may persist even after differences in wRVU are mitigated. Although not addressed in this study, it is important to also examine the implications of payer mix on reimbursement and access.…”

“…More than 30% of children are covered by Medicaid or the Children’s Health Insurance Program nationally, much higher than what was observed in this study . Patient enrollment in Medicaid has been associated with limited access to health care and pediatric dermatology clinic no-shows . Discrepancies in actual reimbursement and access to care in dermatology may persist even after differences in wRVU are mitigated.…”

Defining patient‐centered research priorities in pediatric dermatology

“…The second predominant domain, “health care navigation and disease management,” represents a common challenge for patients and caregivers. Existing barriers in pediatric dermatologic care include financial obstacles (treatment cost, selective insurance acceptance), geographic location, and prolonged wait times 18,19 . Socioeconomic disparity additionally limits access to pediatric dermatologic appointments for minority patients 20 .…”

Teledermatology: How It Is Impacting the Underserved

“…3 Factors associated with access to pediatric dermatologists include finances, wait times, geography, cultural/ethnic beliefs, communication, patient knowledge/beliefs, and health perceptions. 4 Historically, telemedicine, including teledermatology, was established with an intent to overcome access barriers and extend care to rural and underserved communities. However, data from the 2011 Census Bureau's Computer and Internet Use Supplement of the Current Population Survey 5 suggested that patients of low socioeconomic status and rural populations were the least likely to use remote medical services.…”