Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
World Neurosurg. 2021 May;149:e963-e968. doi: 10.1016/j.wneu.2021.01.064. Epub 2021 Jan 28.
The Patient Protection and Affordable Care Act (ACA) sought to expand access to health care for 46 million uninsured Americans. Increasing consumer coverage and ensuring affordability of care have raised concerns about ACA Marketplace plans with limited in-network physician coverage (narrow network plans). We assessed the neurosurgery coverage of ACA Marketplace plans in Arizona.
The Health Insurance Marketplace website was used to identify ACA Marketplace plans in Arizona. Plan-specific details were examined to search for in-network neurosurgeons (2016-2019). Physician- and patient-level information was obtained using Intellimed health care databases, which provide specific neurosurgery diagnosis-related group information.
Although 5 insurance providers offered plans on the ACA Marketplace in Arizona, only 1 plan was available in 13 of 15 counties (87%). Evaluation of in-network coverage found that all in-network outpatient neurosurgery providers are in 5 of 15 counties (33%). Most of the other counties (9 of 10) have neurosurgery facilities, but do not have in-network access to neurosurgical care within the county (∼1.1 million people or 15% of the state population).
By narrowing the network of providers, insurance companies are attempting to maintain fiscal viability of their ACA Marketplace products. However, 10 of the 15 counties (67%) in Arizona do not have access to outpatient neurosurgical care through these plans despite the presence of neurosurgical facilities in most counties. Access to neurosurgical care requires consideration of network coverage in policies designed to expand coverage and coverage options for patients insured through the ACA Marketplace.
《患者保护与平价医疗法案》（ACA）旨在为 4600 万未参保的美国人扩大获得医疗保健的机会。增加消费者的保险覆盖范围并确保医疗服务的可负担性，引发了人们对 ACA 市场计划中网络内医生覆盖范围有限（窄网计划）的担忧。我们评估了亚利桑那州 ACA 市场计划中的神经外科覆盖范围。
使用医疗保险市场网站确定亚利桑那州的 ACA 市场计划。检查特定计划的详细信息，以寻找网络内的神经外科医生（2016-2019 年）。使用 Intellimed 医疗保健数据库获取医生和患者的信息，该数据库提供特定的神经外科诊断相关组信息。
尽管有 5 家保险公司在亚利桑那州的 ACA 市场上提供计划，但只有 1 家计划在 15 个县中的 13 个县（87%）提供。对网络内覆盖范围的评估发现，所有网络内门诊神经外科提供者都在 15 个县中的 5 个县（33%）。其他大多数县（10 个中的 9 个）都有神经外科设施，但在县内没有获得神经外科护理的网络内访问权限（约 110 万人或该州人口的 15%）。
保险公司通过缩小提供商网络，试图维持其 ACA 市场产品的财务可行性。然而，尽管大多数县都有神经外科设施，但亚利桑那州的 15 个县中的 10 个（67%）无法通过这些计划获得门诊神经外科护理。在为通过 ACA 市场投保的患者扩大覆盖范围和覆盖范围选择的政策中，需要考虑网络覆盖范围。
