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Secret Shoppers Find Access To Providers And Network Accuracy Lacking For Those In Marketplace And Commercial Plans.

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...

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Published in:Health Affairs Vol. 35; no. 7; pp. 1160 - 1167
Main Authors: Haeder, Simon F., Weimer, David L., Mukamel, Dana B.
Format: research tables/charts Journal Article
Published: Health Affairs Publishing, LLC Jul2016
Online Access:View this record in EBSCOhost
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      pub: Health Affairs Publishing, LLC
      place: Washington, District of Columbia
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        atl: Secret Shoppers Find Access To Providers And Network Accuracy Lacking For Those In Marketplace And Commercial Plans.
      aug:
        au:
          Haeder, Simon F.
          Weimer, David L.
          Mukamel, Dana B.
        affil: Assistant professor, Department of Political Science, John D. Rockefeller IV School of Policy and Politics, West Virginia University, Morgantown
      sug:
        subj:
          Health Insurance Exchanges
          Health Services Accessibility Trends
          Patient Protection and Affordable Care Act
          Primary Health Care
          United States
          Insurance, Health Economics
          Human
      ab: 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.
      pubtype: Academic Journal
      doctype:
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        tables/charts
        Journal Article
      ougenre: Article
    language: English
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