Is Access to Outpatient Neurosurgery Affected by Narrow Insurance Networks? Results From Statewide Analysis of Marketplace Plans in Louisiana
Is Access to Outpatient Neurosurgery Affected by Narrow Insurance Networks? Results From Statewide Analysis of Marketplace Plans in Louisiana
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DOI：
10.1093/neuros/nyx632
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发表时间：
2019-01-01
期刊：
影响因子：
4.8
通讯作者：
Tumialan, Luis M.
中科院分区：
文献类型：
--
作者：
Dossani, Rimal H.;Kalakoti, Piyush;Tumialan, Luis M.
背景：《平价医疗法案》(ACA) 的主要目标是让所有美国人都能负担得起医疗保险，同时解决 4800 万人缺乏保险的问题。面对快速增加的注册人数和对廉价计划不断增长的需求，保险公司正在限制网络内的医生。提供网络内医生有限的计划的提供商网络已被称为“窄网络”。 目的：评估路易斯安那州门诊神经外科的 ACA 市场计划的充分性。方法：在市场公共使用文件中搜索所有“白银”计划。路易斯安那州总共确定了 7 个白银计划。使用该计划的在线目录，对路易斯安那州人口超过 10 万的教区的网络内神经外科医生进行了搜索。主要结果是在白银计划中，每个人口超过 10 万的教区在选定邮政编码 50 英里范围内缺乏网络内神经外科医生。没有网络内神经外科医生的计划被标记为神经外科医生不足的计划。结果：路易斯安那州的几个计划是神经外科医生不足的，即指定教区邮政编码 50 英里范围内没有网络内神经外科医生。 A 公司的计划 3 在所有 5 个教区中都存在缺陷，而 C 公司和 D 公司的白银计划在 14 个教区中的 4 个（29%）中存在缺陷。所有县和计划的综合结果表明，路易斯安那州所有银计划中的 43%（7 个中的 3 个）在至少 4 个人口 > 100 000 的教区中缺乏神经外科医生。 结论：在路易斯安那州，狭窄的网络限制了 ACA 银计划患者获得神经外科护理的机会。
BACKGROUND: The main objective of the Affordable Care Act (ACA) was to make health insurance affordable to all Americans while addressing the lack of coverage for 48 million people. In the face of rapidly increasing enrollment and rising demand for inexpensive plans, insurance providers are limiting in-network physicians. Provider networks offering plans with limited in-network physicians have become known as "narrow networks."OBJECTIVE: To assesses the adequacy of ACA marketplace plans for outpatient neurosurgery in Louisiana.METHODS: The Marketplace Public Use Files were searched for all "silver" plans. A total of 7 silver plans were identified in Louisiana. Using the plans'online directories, a search of in-network neurosurgeons in Louisiana parishes with >100 000 population was performed. The primary outcome was lack of in-network neurosurgeon(s) in silver plans within 50 miles of selected zip code for each parish with >100 000 population. Plans without in-network neurosurgeon(s) are labeled as neurosurgeon-deficient plans.RESULTS: Several plans in Louisiana are neurosurgeon deficient, ie no in-network neurosurgeon within 50 miles of the designated parish zip code. Company A's plan 3 is deficient in all 5 parishes, while company C and company D silver plans are deficient in 4 out of 14 (29%). Combined results from all counties and plans demonstrate that 43% (3 out of 7) of all silver plans in Louisiana are neurosurgeon deficient in at least 4 parishes with population >100 000.CONCLUSION: In Louisiana, narrow networks have limited access to neurosurgical care for those patients with ACA silver plans.