Secret Shoppers Find Access To Providers And Network Accuracy Lacking For Those In Marketplace And Commercial Plans
Secret Shoppers Find Access To Providers And Network Accuracy Lacking For Those In Marketplace And Commercial Plans
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DOI：
10.1377/hlthaff.2015.1554
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发表时间：
2016-07-01
期刊：
影响因子：
9.7
通讯作者：
Mukamel, Dana B.
中科院分区：
文献类型：
--
作者：
Haeder, Simon F.;Weimer, David L.;Mukamel, Dana B.
最近，通过根据《平价医疗法案》建立的保险市场销售的计划的提供者网络的充分性受到了广泛的审查。各种研究表明，网络通常是狭窄的。为了了解更多关于网络充分性和获得护理的信息，我们调查了两个问题。首先，无论网络的名义规模如何，患者能否及时获得他们选择的提供者提供的初级保健服务？第二，与保险市场以外销售的计划相比，访问权如何？我们在2015年夏天对来自加州19个保险市场定价地区中的5个地区的743名初级保健提供者进行了一项“秘密购物者”调查。我们的研究结果表明，获得初级保健提供者的机会通常在保险市场内外都同样具有挑战性。在不到30%的情况下，消费者能够与最初选择的医生提供者预约。有关供应商网络的信息往往不准确。急性病患者获得服务的问题尤其令人不安。有效解决网络充足性问题需要更准确的提供商信息。
The adequacy of provider networks for plans sold through insurance Marketplaces established under the Affordable Care Act has received much scrutiny recently. Various studies have established that networks are generally narrow. To learn more about network adequacy and access to care, we investigated two questions. First, no matter the nominal size of a network, can patients gain access to primary care services from providers of their choice in a timely manner? Second, how does access compare to plans sold outside insurance Marketplaces? We conducted a "secret shopper" survey of 743 primary care providers from five of California's nineteen insurance Marketplace pricing regions in the summer of 2015. Our findings indicate that obtaining access to primary care providers was generally equally challenging both inside and outside insurance Marketplaces. In less than 30 percent of cases were consumers able to schedule an appointment with an initially selected physician provider. Information about provider networks was often inaccurate. Problems accessing services for patients with acute conditions were particularly troubling. Effectively addressing issues of network adequacy requires more accurate provider information.