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March 1997

Managed Care: A Cautionary Note

Arch Dermatol. 1997;133(3):391. doi:10.1001/archderm.1997.03890390135027

Kudos to the editors for the September 1996 Managed Care Issue of the Archives. I would like to make 2 related points.

How Will Dermatologists Prove Their Worth to the Health Care Industry?  I am concerned that we have spent too much time attempting to prove our cost-effectiveness and inadequate time proving our quality-of-care effectiveness. As Lober1 states, dermatologists can provide "the highest-quality skin care in a cost-efficient manner." We provide more cost-effective care than nonspecialized primary care physicians, if the goal is to provide excellent dermatological care. Dermatologists, however, deal with many chronic problems that are debilitating but not life-threatening. This leaves us vulnerable to another alternative: poor quality dermatological care. A managed care provider could, consciously or otherwise, elect to restrict patient access to dermatologists, relying solely on inadequately trained primary care physicians and accepting the resulting debilitating but rarely fatal impact of poor dermatological care