Networks In ACA Marketplaces Are Narrower For Mental Health Care Than For Primary Care
Networks In ACA Marketplaces Are Narrower For Mental Health Care Than For Primary Care
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DOI：
10.1377/hlthaff.2017.0325
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发表时间：
2017-09-01
期刊：
影响因子：
9.7
通讯作者：
Polsky, Daniel
中科院分区：
文献类型：
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作者：
Zhu, Jane M.;Zhang, Yuehan;Polsky, Daniel
窄网计划通常被定义为在一个特定的健康保险市场中包括少于25%的提供者的计划，它在多大程度上影响了消费者对专业提供者的选择和获得——特别是在精神卫生保健方面。使用2016年《平价医疗法案》市场中531个独特提供者网络的数据，我们评估了网络规模和参与任何网络的提供者百分比在精神卫生保健提供者和初级保健提供者对照组之间的差异。与初级保健网络相比，精神卫生网络的参与率较低，只有42.7%的精神科医生和19.3%的非医生精神卫生保健提供者参与任何网络。平均而言，计划网络包括24.3%的所有初级保健提供者和11.3%的所有精神卫生保健提供者在给定的州一级市场上执业。这些发现提出了一个重要的问题，即在实现精神健康平等规定的目标方面，提供者方面存在障碍：保险公司将精神健康服务与普通医疗和外科服务相提并论。共同努力增加精神卫生保健提供者对网络的参与，同时加强对网络规模和组成的监管，可以改善消费者的选择，并补充实现精神卫生平等的努力。
There is increasing concern about the extent to which narrow-network plans, generally defined as those including fewer than 25 percent of providers in a given health insurance market, affect consumers' choice of and access to specialty providers-particularly in mental health care. Using data for 2016 from 531 unique provider networks in the Affordable Care Act Marketplaces, we evaluated how network size and the percentage of providers who participate in any network differ between mental health care providers and a control group of primary care providers. Compared to primary care networks, participation in mental health networks was low, with only 42.7 percent of psychiatrists and 19.3 percent of nonphysician mental health care providers participating in any network. On average, plan networks included 24.3 percent of all primary care providers and 11.3 percent of all mental health care providers practicing in a given state-level market. These findings raise important questions about provider-side barriers to meeting the goal of mental health parity regulations: that insurers cover mental health services on a par with general medical and surgical services. Concerted efforts to increase network participation by mental health care providers, along with greater regulatory attention to network size and composition, could improve consumer choice and complement efforts to achieve mental health parity.