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Narrow network plans – saving, yes, but it’s also troubling

http://www.nytimes.com/2016/10/18/upshot/savings-yes-but-narrow-health-networks-also-show-troubling-signs.html

Currently, insurers are offering more narrow network plans, which have annual premium lower than broader networks. A very narrow network covers care by less than 10% of the physicians while a normal to broad networks cover up to 60% of physicians. Records of people who switched to narrow network plans with Massachusetts Group Insurance Commission in 2012 suggested that the main savings were probably achieved by more efficient use of the health system, especially for enrollees who retained their primary care physicians. The distance travelled for primary care visits fell drastically, accounting for much of the 36% saving in patients’ healthcare expense. However, the results of a recent study by Simon Haeder, a west Virginia University political scientist and colleagues at the University of Wisconsin-Madison and the University of California, showed that the savings in healthcare were actually because the narrow network plans make it harder for patients to get care. Using a “secret shopper” approach, the researchers found that only about 30% of the attempts for appointments with specific primary care doctors were successful. The reasons for this very low success rate include doctors not accepting the plans or new patients, extremely busy phone numbers, long waiting time for physical exam, wrong phone numbers listed in the directory, and doctors called not being primary care physicians.

The narrow network plan relates to our discussion of power in a network. As someone switches to the narrow network plans, they have less options of physicians to connect. Therefore, narrow network plan enrollee has less “power” in hand. Meanwhile the primary care physicians retained by those who switch to the new narrow network plans will have more power relative to their patients. These doctors can be extremely busy, and thus can choose to have appointments with narrow network plan patients or not, or may leave them with more waiting time to first serve patients with better insurance plan, those who have more options or more “buying power”. The result is that patients with narrow network plan will have a harder time to get the healthcare they deserve. While the savings in premium is surely attractive, narrow network plans may actually do more harm than good for enrollees who need specific primary care.

 

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