A Consumer-Centric Approach To Network Adequacy: Access To Four Specialties In California’s Marketplace

We assessed the effect of provider networks on access to four medical specialties for Affordable Care Act Marketplace enrollees in California. Our approach incorporated a crucial consumer-focused attribute, travel distance, and identified the restrictions on provider access resulting from network de...

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Bibliographic Details
Published in:Health Affairs 2019-11, Vol.38 (11), p.1918-1926
Main Authors: Haeder, Simon F., Weimer, David, Mukamel, Dana B.
Format: Article
Language:English
Subjects:
Access
Adequacy
Cardiology
Censuses
Consumers
Endocrinology
Health care policy
Health maintenance organizations
HMOs
Internet
Medicaid
Medicare
Metropolitan areas
Networks
Patient Protection & Affordable Care Act 2010-US
Pediatrics
Quality
Regulation
Rural areas
Rural communities
Travel
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Summary:We assessed the effect of provider networks on access to four medical specialties for Affordable Care Act Marketplace enrollees in California. Our approach incorporated a crucial consumer-focused attribute, travel distance, and identified the restrictions on provider access resulting from network design. Our analysis indicated that Marketplace plan networks are narrower than their commercial plan counterparts and feature just over half as many providers. However, there is much diversity in network breadth, depending on consumers' choice of plans and geographic region. Furthermore, network designs often create important access issues for consumers because of what we call "artificial local provider deserts"-geographic areas within networks devoid of providers by design. Consumers in large metropolitan areas are generally guaranteed a significant degree of access and choice, but network design exacerbates limited access for rural areas in which few providers are available to any consumer.
ISSN:0278-2715
1544-5208
DOI:10.1377/hlthaff.2019.00116