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Going the Extra Mile? How Provider Network Design Increases Consumer Travel Distance, Particularly for Rural Consumers.

Authors
  • Haeder, Simon F1
  • Weimer, David L2
  • Mukamel, Dana B3
  • 1 Pennsylvania State University.
  • 2 University of Wisconsin-Madison.
  • 3 University of California Irvine.
Type
Published Article
Journal
Journal of health politics, policy and law
Publication Date
Dec 01, 2020
Volume
45
Issue
6
Pages
1107–1136
Identifiers
DOI: 10.1215/03616878-8641591
PMID: 32464649
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

The practical accessibility to medical care facilitated by health insurance plans depends not just on the number of providers within their networks but also on distances consumers must travel to reach the providers. Long travel distances inconvenience almost all consumers and may substantially reduce choice and access to providers for some. The authors assess mean and median travel distances to cardiac surgeons and pediatricians for participants in (1) plans offered through Covered California, (2) comparable commercial plans, and (3) unrestricted open-network plans. The authors repeat the analysis for higher-quality providers. The authors find that in all areas, but especially in rural areas, Covered California plan subscribers must travel longer than subscribers in the comparable commercial plan; subscribers to either plan must travel substantially longer than consumers in open networks. Analysis of access to higher-quality providers show somewhat larger travel distances. Differences between ACA and commercial plans are generally substantively small. While network design adds travel distance for all consumers, this may be particularly challenging for transportation-disadvantaged populations. As distance is relevant to both health outcomes and the cost of obtaining care, this analysis provides the basis for more appropriate measures of network adequacy than those currently in use. Copyright © 2020 by Duke University Press.

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