Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Johns Hopkins Carey School of Business, Baltimore, MD, USA.
Med Care Res Rev. 2024 Aug;81(4):327-334. doi: 10.1177/10775587241241975. Epub 2024 Apr 5.
Over 70% of Medicaid beneficiaries are enrolled in Medicaid managed care (MMC). MMC provider networks therefore represent a critical determinant of access to the Medicaid program. Many MMC insurers also participate in commercial insurance markets where prices are high, and some insurers exercise considerable market power. In this paper, we examined the relationship between commercial insurer market power and MMC physician network breadth using linked national enrollment data and provider directory data. Insurers with more commercial market power had broader Medicaid physician networks. Insurers with over 30% market share had 37.3% broader Medicaid networks than insurers in the same county that had no commercial market share. These differences were driven by greater breadth among primary care providers, as well as other specialists including OB/GYNs, surgeons, neurologists, and cardiologists. Commercial insurance market power may have spillovers on access to care for MMC beneficiaries.
超过 70%的医疗补助受益人参加了医疗补助管理式医疗（MMC）。因此，MMC 供应商网络是获得医疗补助计划的关键决定因素。许多 MMC 保险公司还参与价格较高的商业保险市场，其中一些保险公司拥有相当大的市场力量。在本文中，我们使用关联的全国参保数据和供应商目录数据，考察了商业保险公司市场力量与 MMC 医生网络广度之间的关系。商业市场力量较强的保险公司拥有更广泛的医疗补助医生网络。在拥有 30%以上市场份额的保险公司中，其医疗补助网络比在同一县没有商业市场份额的保险公司宽 37.3%。这些差异是由初级保健提供者以及妇产科医生、外科医生、神经科医生和心脏病专家等其他专科医生之间的更大广度驱动的。商业保险市场力量可能会对 MMC 受益人的医疗服务获取产生溢出效应。
