Department of Neurosurgery, Rutgers- Robert Wood Johnson Medical School & University Hospital, New Brunswick, New Jersey, USA.
Rutgers School of Biomedical and Health Sciences, Piscataway, New Jersey, USA.
World Neurosurg. 2020 Sep;141:e213-e222. doi: 10.1016/j.wneu.2020.05.086. Epub 2020 May 17.
The aftermath of the Affordable Care Act (ACA) witnessed the rise of narrow networks, which feature fewer providers in exchange for lower premiums. Debate still continues on whether narrow networks provide adequate access to health care, especially in specialty care services such as neurosurgery. The objective of this article was to analyze the 2019 Marketplace plans' impact on delivering outpatient neurosurgical care in New Jersey.
The 2019 Marketplace Public Use Files were queried for "silver" plans, identifying a total of 11 plans across 3 insurance companies. Online search engines were used to identify the number of in-network neurosurgeons within 20-25 miles of ZIP codes at the center of each county. The primary outcome was the number of neurosurgeon-deficient plans, defined as those having no in-network neurosurgeons within the assigned mile radius.
Of all individuals who purchased an insurance plan, 73% (185,797/255,246) opted for a silver plan. Out of 111 active neurosurgeons in New Jersey, 25% (28/111) did not participate in any of the silver plans. Analysis showed 8 plans as neurosurgeon-deficient in Sussex and Warren. Meanwhile, most of the silver plans provided access to >5 neurosurgeons within 20-25 miles of most (17/21) county centers.
In more densely populated states such as New Jersey, the impact of narrow networks on neurosurgical coverage is less apparent. However, frustrations regarding access to care still exist because nearly 25% of neurosurgeons do not participate in the standard ACA insurance product. Furthermore, guidelines that define network adequacy in neurosurgery remain elusive, which calls for more robust parameters to monitor and ensure adequate access to health care.
《平价医疗法案》（ACA）实施后，窄网医保计划兴起，该计划以减少参保人数为代价，降低保费。关于窄网医保计划是否能为人们提供充分的医疗服务，特别是在神经外科等专科医疗服务方面，仍存在争议。本文旨在分析 2019 年市场医保计划对新泽西州提供门诊神经外科护理的影响。
查询 2019 年市场公共使用文件中的“银”计划，确定了 3 家保险公司的 11 个计划。利用在线搜索引擎，确定了每个县中心 20-25 英里范围内的医保计划内神经外科医生数量。主要结果是神经外科医生短缺计划的数量，定义为在指定英里半径内没有医保计划内神经外科医生的计划。
在购买保险计划的所有人群中，73%（185797/255246）选择了银计划。在新泽西州的 111 名活跃神经外科医生中，25%（28/111）没有参与任何银计划。分析显示，在苏塞克斯县和沃伦县有 8 个计划缺乏神经外科医生。同时，大多数银计划在距离 21 个县中心大多数（17/21）的 20-25 英里范围内提供了超过 5 名神经外科医生。
在人口更密集的州，如新泽西州，窄网医保计划对神经外科覆盖范围的影响不太明显。然而，人们对获得医疗服务的不满仍然存在，因为近 25%的神经外科医生不参与标准的 ACA 医疗保险产品。此外，神经外科网络充足性的指导方针仍然难以确定，这需要更强大的参数来监测和确保获得充足的医疗服务。
