دورية أكاديمية
أعرض في EDS

Access to Neurosurgery in the Era of Narrowing Insurance Networks: Statewide Analysis of Patient Protection and Affordable Care Act Marketplace Plans in Arizona.

التفاصيل البيبلوغرافية
العنوان: Access to Neurosurgery in the Era of Narrowing Insurance Networks: Statewide Analysis of Patient Protection and Affordable Care Act Marketplace Plans in Arizona.
المؤلفون: Potla S; Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA., Cole TS; Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA., Mulholland CB; Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA., Tumialán LM; Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA. Electronic address: Neuropub@barrowneuro.org.
المصدر: World neurosurgery [World Neurosurg] 2021 May; Vol. 149, pp. e963-e968. Date of Electronic Publication: 2021 Jan 28.
نوع المنشور: Journal Article
اللغة: English
بيانات الدورية: Publisher: Elsevier Country of Publication: United States NLM ID: 101528275 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1878-8769 (Electronic) Linking ISSN: 18788750 NLM ISO Abbreviation: World Neurosurg Subsets: MEDLINE
أسماء مطبوعة: Original Publication: New York : Elsevier
مواضيع طبية MeSH: Health Insurance Exchanges*, Ambulatory Care/*statistics & numerical data , Health Maintenance Organizations/*statistics & numerical data , Health Services Accessibility/*statistics & numerical data , Insurance Coverage/*statistics & numerical data , Neurosurgeons/*statistics & numerical data, Arizona ; Humans ; Insurance, Health ; Neurosurgery ; Patient Protection and Affordable Care Act
مستخلص: Objective: 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.
Methods: 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.
Results: 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).
Conclusions: 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.
(Copyright © 2021 Elsevier Inc. All rights reserved.)
فهرسة مساهمة: Keywords: Access to care; Health insurance; Marketplace plans; Narrow networks; Neurosurgery; Patient Protection and Affordable Care Act; Physician coverage
تواريخ الأحداث: Date Created: 20210130 Date Completed: 20210809 Latest Revision: 20210809
رمز التحديث: 20221213
DOI: 10.1016/j.wneu.2021.01.064
PMID: 33515792
قاعدة البيانات: MEDLINE
الوصف
تدمد:1878-8769
DOI:10.1016/j.wneu.2021.01.064