Chima D. Ndumele (
Becky Staiger is a graduate student in the Department of Health Policy and Management, Yale School of Public Health.
Health Aff (Millwood). 2018 Jun;37(6):929-935. doi: 10.1377/hlthaff.2017.1410.
Health plans use selective physician networks to control costs while improving quality. However, narrow (limited) networks raise concerns about reduced access to and continuity of care. In the period 2010-15, the proportion of Medicaid managed care plans in fourteen states with narrow primary care physician networks-that is, the plans that employed 30 percent or less of those physicians in their market-declined from a peak of 42 percent in 2011 to 27 percent in 2015. On average, plans experienced a 12 percent annual turnover rate, with 34 percent of primary care physicians exiting within five years. Turnover was 3 percentage points higher in plans with narrow networks after one year, and 20 percentage points higher after five years, compared to turnover in plans with non-narrow networks. These findings suggest that efforts to maintain adequate physician networks must monitor not only the breadth of the networks, but also the continuity within them.
健康计划利用选择性医生网络来控制成本，同时提高质量。然而，狭窄（有限）的网络引起了人们对医疗服务获取和连续性的担忧。在 2010 年至 2015 年期间，在 14 个州，拥有狭窄初级保健医生网络的医疗补助管理式医疗计划（即那些在市场上雇佣了 30%或以下医生的计划）的比例从 2011 年的 42%的峰值下降到 2015 年的 27%。平均而言，计划的年度人员流动率为 12%，其中 34%的初级保健医生在五年内离职。与非狭窄网络计划相比，在网络狭窄的计划中，一年后的人员流动率高出 3 个百分点，五年后高出 20 个百分点。这些发现表明，为维持足够的医生网络所做的努力不仅必须监测网络的广度，还必须监测网络内的连续性。
