Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana.
Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona.
Neurosurgery. 2019 Jan 1;84(1):50-59. doi: 10.1093/neuros/nyx632.
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."
To assesses the adequacy of ACA marketplace plans for outpatient neurosurgery in Louisiana.
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.
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.
In Louisiana, narrow networks have limited access to neurosurgical care for those patients with ACA silver plans.
平价医疗法案（ACA）的主要目标是使所有美国人都能负担得起医疗保险，同时解决 4800 万人没有医疗保险的问题。面对不断增加的参保人数和对廉价计划的需求不断增加，保险公司正在限制网络内医生。提供网络内医生数量有限的计划的供应商网络已被称为“窄网络”。
评估路易斯安那州平价医疗法案市场计划对外科神经科门诊的充分性。
在市场公共使用文件中搜索所有“银”计划。在路易斯安那州共确定了 7 种银计划。使用这些计划的在线目录，对路易斯安那州每个人口超过 10 万的县的网络内神经外科医生进行了搜索。主要结果是在每个人口超过 10 万的县的选定邮政编码的 50 英里范围内，银计划中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。
路易斯安那州的几个计划缺乏神经外科医生，即在指定的教区邮政编码 50 英里范围内没有网络内神经外科医生。公司 A 的计划 3 在所有 5 个教区都缺乏，而公司 C 和公司 D 的银计划在 14 个中的 4 个（29%）缺乏。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有 43%（3 个中的 3 个）在至少 4 个人口超过 10 万的教区缺乏神经外科医生。
在路易斯安那州，那些拥有 ACA 银计划的患者，窄网络限制了获得神经外科护理的机会。
