Department of Health Policy and Management, Texas A&M University, 4226 Wallaceshire Ct, College Station, TX 77845. Email:
Am J Manag Care. 2024 Sep;30(9):424-432. doi: 10.37765/ajmc.2024.89601.
Most Americans have insurance that uses managed care arrangements. Regulators have long sought to ensure access to care through network adequacy regulations. However, consumers have largely been excluded from conversations about network adequacy. To our knowledge, our study is the first to assess consumer preferences for various definitions of network adequacy including those aimed at supporting health equity and reducing disparities.
We fielded a large and demographically diverse survey of US adults (N = 4008) from June 30 to July 2, 2023. The survey queried respondents about their perceptions of what adequate provider networks look like in the abstract.
Analyses were conducted using ordinary least squares regression with survey weights as well as t tests.
Consumers were overwhelmingly supportive of standard definitions of adequacy focused on the number of providers and travel distance. Majorities also favored more expansive, health equity-focused definitions such as public transportation access, cultural competency, and lesbian, gay, bisexual, and transgender (LGBT+)-inclusive care. Being a woman; having higher levels of education, worse health, and recent experiences with the medical system; and ease of completing administrative tasks were relatively consistent positive predictors of supporting more expansive definitions. More controversial definitions saw effects of partisanship and LGBT+ identification. Rurality, insurance status, education, and recent experiences with the medical system affected perceptions of reasonable appointment wait times and travel distances.
Our findings indicate that consumers have broad conceptions of network adequacy. Future work should assess consumer trade-offs in resource-constrained settings as well as perceptions of providers and carriers.
大多数美国人的保险都采用管理式医疗安排。长期以来，监管机构一直致力于通过网络充足性规定来确保获得医疗服务的机会。然而，消费者在很大程度上被排除在关于网络充足性的讨论之外。据我们所知，我们的研究是第一个评估消费者对各种网络充足性定义的偏好的研究，包括那些旨在支持健康公平和减少差距的定义。
我们于 2023 年 6 月 30 日至 7 月 2 日对美国成年人（N=4008）进行了一项大型的、人口统计学上多样化的调查。该调查询问了受访者对抽象的充足提供者网络的看法。
使用普通最小二乘法回归和调查权重以及 t 检验进行分析。
消费者压倒性地支持以提供者数量和旅行距离为重点的标准充足性定义。大多数人也赞成更广泛的、关注健康公平的定义，例如公共交通接入、文化能力和男女同性恋、双性恋和跨性别者（LGBT+）包容的护理。女性、更高的教育水平、更差的健康状况和最近的医疗系统体验以及完成行政任务的便利性是支持更广泛定义的相对一致的积极预测因素。更具争议性的定义则受到党派和 LGBT+认同的影响。农村地区、保险状况、教育程度和最近的医疗系统体验影响对合理预约等待时间和旅行距离的看法。
我们的研究结果表明，消费者对网络充足性有广泛的概念。未来的研究应该评估在资源有限的情况下消费者的权衡，以及对提供者和运营商的看法。
