Health care delivery model effects on access to dermatologic care

Introduction: In contrast to direct access (DA) health care models, gatekeeper (GK) models require a referral for specialist evaluation. Upon dermatologist evaluation, a skin biopsy may be necessary. Under the gatekeeper model, preauthorization is required to perform this procedure. This entails that the patient visit his primary care provider (PCP) to obtain authorization and a following appointment for dermatologic biopsy. This introduces a waiting time to diagnosis and treatment. This is of concern in patients with melanoma, where staging correlates with survival.