Aditi P. Sen (
Lena M. Chen is an assistant professor of internal medicine at the University of Michigan and a physician in the Veterans Affairs Ann Arbor Health Care System, both in Ann Arbor.
Health Aff (Millwood). 2017 Sep 1;36(9):1615-1623. doi: 10.1377/hlthaff.2016.1582.
The Affordable Care Act allows commercial insurers participating in the Marketplaces to vary the size of their provider networks as long as the providers are "sufficient" in numbers and types. Concerns have been growing over the increasing use of restricted-provider or narrow networks in Marketplace plans because of their implications for reduced access to care, but little is known about the breadth and stability of these networks over time or what types of enrollees choose such plans. Using national data, we found that in 2016, 60 percent of provider networks in plans offered in the federally facilitated Marketplaces included at least one-quarter of local-area physicians, and that consumers' access to broad-network plans remained stable between 2015 and 2016. Hispanic and low-income people made up a disproportionate share of enrollees in smaller-network plans (those with fewer than one-quarter of local-area physicians). It will be important to monitor the impact of narrow networks on access to and quality of care as well as on health outcomes.
平价医疗法案允许参与市场的商业保险公司根据供应商数量和类型的“充足性”来调整其供应商网络的规模。由于受限制供应商或窄供应商网络对降低医疗服务可及性的影响，人们对其在市场计划中的使用日益增加表示担忧，但人们对这些网络的广度和稳定性随时间的变化以及选择这些计划的是哪类参保人知之甚少。我们利用全国性数据发现，2016 年，联邦管理的市场中提供的计划中的供应商网络中有 60%至少包括四分之一的当地医生，消费者获得广泛网络计划的机会在 2015 年至 2016 年期间保持稳定。西班牙裔和低收入人群在小网络计划（那些只有不到四分之一的当地医生）中参保的比例不成比例。监测窄供应商网络对医疗服务的可及性和质量以及对健康结果的影响将非常重要。
