Most health insurance plans in the United States manage costs by financially incentivizing participants to obtain health care within a network of health care providers. Insurance regulators set requirements, called network adequacy standards, to pressure networks to meet federal or state standards for access to health care. These standards include such things as providing sufficient health care providers in various specialties within a reasonable distance of plan participants.
A major obstacle to ensuring an adequate supply of providers is that the concept of network adequacy is vague, leaving policymakers with little objective data to guide their decisions.
To help fill this gap, Simon Haeder, Ph.D., associate professor of health policy and management at Texas A&M University School of Public Health, and a colleague at Ohio State University conducted a survey of a key stakeholder in the managed healthcare: patients .
“Consumers could provide valuable information about which facets of provider networks they think are important to network suitability, but until now they have never been asked for their opinions on what an ‘adequate’ network should look like,” Haeder said.
The studypublished in the American Journal of Managed Caresurveyed 4,008 demographically diverse adults in the United States about their perceptions of what adequate health care networks look like in the abstract, including travel time and concepts related to health equity. The survey was conducted from June 30 to July 2, 2023.
Statistical analyzes of responses found strong support for definitions of adequacy regarding timely access to primary care (81.9%), specialty care (82.6%), and mental health care (82.6%). Similar support was also expressed for reasonable travel times: primary care (80.5%), specialist care (78.6%) and mental health care (80.6%).
Respondents defined acceptable travel distances as 26.04 minutes for primary care, 30.34 minutes for specialist care and 27.49 minutes for mental health care.
Most respondents also wanted to broaden definitions of network adequacy to include health equity issues such as access to public transportation (67.3%), cultural competency (57.4%), and LGBT+ inclusive care (57.2% ). Respondents who were female, had higher levels of education, had poorer health, and/or had recent experiences with the medical system expressed more support for these expanded definitions.
“Overall, we found that health plan members have a broader view of network eligibility than is currently the case,” Haeder said. “That means additional work is needed to determine what tradeoffs consumers would support, given that resources are limited, as well as consumers’ perceptions of providers and carriers.”
The article is part of a broader research project that aims to increase our understanding of how patients navigate healthcare provider networks and the challenges they face in accessing care. Other papers from the portfolio have been reviewed how states regulate provider networksWhat challenges consumers have when using supplier directories and how this affects their attitudes towards government actionAnd how long inaccurate entries remain in the providers’ directories.
More information:
When is a network adequate? Consumer perspectives on definitions of network adequacy, The American Journal of Managed Care (2024). DOI: 10.37765/ajmc.2024.89601
Quote: Patients say access to health care is more than just travel time and being seen quickly (2024, October 15) retrieved October 15, 2024 from https://medicalxpress.com/news/2024-10-patients-access-health-quickly . html
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