Division of Adolescent Medicine, Department of Pediatrics, The Children's Hospital of Philadelphia.
Leonard Davis Institute of Health Economics, and.
Pediatrics. 2017 Apr;139(4). doi: 10.1542/peds.2016-3117. Epub 2017 Mar 1.
To describe and compare pediatric and adult specialty physician networks in marketplace plans.
Data on physician networks, including physician specialty and address, in all 2014 individual marketplace silver plans were aggregated. Networks were quantified as the fraction of providers in the underlying rating area within a state that participated in the network. Narrow networks included none available networks (ie, no providers available in the underlying area) and limited networks (ie, included <10% of the available providers in the underlying area). Proportions of narrow networks between pediatric and adult specialty providers were compared.
Among the 1836 unique silver plan networks, the proportions of narrow networks were greater for pediatric (65.9%) than adult specialty (34.9%) networks ( < .001 for all specialties). Specialties with the highest proportion of narrow networks for children were infectious disease (77.4%) and nephrology (74.0%), and they were highest for adults in psychiatry (49.8%) and endocrinology (40.8%). A larger proportion of pediatric networks (43.8%) had no available specialists in the underlying area when compared with adult networks (10.4%) ( < .001 for all specialties). Among networks with available specialists in the underlying area, a higher proportion of pediatric (39.3%) than adult (27.3%) specialist networks were limited ( < .001 except psychiatry).
Narrow networks were more prevalent among pediatric than adult specialists, because of both the sparseness of pediatric specialists and their exclusion from networks. Understanding narrow networks and marketplace network adequacy standards is a necessary beginning to monitor access to care for children and families.
描述和比较市场计划中儿科和成人专科医生网络。
汇总了 2014 年所有个人市场银计划中关于医生网络的数据，包括医生专业和地址。网络通过参与网络的州内基础评级区域内的提供者比例来量化。狭义网络包括没有可用网络（即在基础区域内没有可用的提供者）和有限网络（即在基础区域内包括<10%的可用提供者）。比较了儿科和成人专科医生之间狭义网络的比例。
在 1836 个独特的银计划网络中，狭义网络的比例在儿科（65.9%）高于成人专科（34.9%）网络（所有专业均<.001）。儿科狭义网络比例最高的专业是传染病学（77.4%）和肾脏病学（74.0%），而成人则是精神病学（49.8%）和内分泌学（40.8%）。与成人网络（10.4%）相比，基础区域内没有可用专科医生的儿科网络比例（43.8%）更高（所有专业均<.001）。在基础区域内有可用专科医生的网络中，儿科（39.3%）比成人（27.3%）专科医生网络的限制比例更高（除精神病学外，均<.001）。
儿科专家比成人专家的狭义网络更为普遍，这是由于儿科专家的稀缺性以及他们被排除在网络之外。了解狭义网络和市场网络充足性标准是监测儿童和家庭获得医疗服务的必要起点。
