Pediatric and Adult Physician Networks in Affordable Care Act Marketplace Plans
To describe and compare pediatric and adult specialty physician networks in marketplace plans. Data on physician networks, including physician specialty and address, in all 2014 individual marketplace silver plans were aggregated. Networks were quantified as the fraction of providers in the underlyi...
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| Veröffentlicht in: | Pediatrics (Evanston) 2017-04, Vol.139 (4), p.1 |
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| container_title | Pediatrics (Evanston) |
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| creator | Wong, Charlene A Kan, Kristin Cidav, Zuleyha Nathenson, Robert Polsky, Daniel |
| description | To describe and compare pediatric and adult specialty physician networks in marketplace plans.
Data on physician networks, including physician specialty and address, in all 2014 individual marketplace silver plans were aggregated. Networks were quantified as the fraction of providers in the underlying rating area within a state that participated in the network. Narrow networks included none available networks (ie, no providers available in the underlying area) and limited networks (ie, included |
| doi_str_mv | 10.1542/peds.2016-3117 |
| format | Article |
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Data on physician networks, including physician specialty and address, in all 2014 individual marketplace silver plans were aggregated. Networks were quantified as the fraction of providers in the underlying rating area within a state that participated in the network. Narrow networks included none available networks (ie, no providers available in the underlying area) and limited networks (ie, included <10% of the available providers in the underlying area). Proportions of narrow networks between pediatric and adult specialty providers were compared.
Among the 1836 unique silver plan networks, the proportions of narrow networks were greater for pediatric (65.9%) than adult specialty (34.9%) networks (
< .001 for all specialties). Specialties with the highest proportion of narrow networks for children were infectious disease (77.4%) and nephrology (74.0%), and they were highest for adults in psychiatry (49.8%) and endocrinology (40.8%). A larger proportion of pediatric networks (43.8%) had no available specialists in the underlying area when compared with adult networks (10.4%) (
< .001 for all specialties). Among networks with available specialists in the underlying area, a higher proportion of pediatric (39.3%) than adult (27.3%) specialist networks were limited (
< .001 except psychiatry).
Narrow networks were more prevalent among pediatric than adult specialists, because of both the sparseness of pediatric specialists and their exclusion from networks. Understanding narrow networks and marketplace network adequacy standards is a necessary beginning to monitor access to care for children and families.</description><identifier>ISSN: 0031-4005</identifier><identifier>EISSN: 1098-4275</identifier><identifier>DOI: 10.1542/peds.2016-3117</identifier><identifier>PMID: 28250022</identifier><identifier>CODEN: PEDIAU</identifier><language>eng</language><publisher>United States: American Academy of Pediatrics</publisher><subject>Adult ; Adults ; Child ; Company business management ; Health Insurance Exchanges - statistics & numerical data ; Health Services Accessibility - statistics & numerical data ; Humans ; Management ; Marketplaces ; Patient Protection & Affordable Care Act 2010-US ; Patient Protection and Affordable Care Act - statistics & numerical data ; Pediatrics ; Physicians ; Physicians - statistics & numerical data ; Practice ; United States</subject><ispartof>Pediatrics (Evanston), 2017-04, Vol.139 (4), p.1</ispartof><rights>Copyright © 2017 by the American Academy of Pediatrics.</rights><rights>Copyright American Academy of Pediatrics Apr 2017</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c401t-21f964257890d03cdbd58c523dd3a9470b6a204756f3bab754ba8f75e66f890a3</citedby><cites>FETCH-LOGICAL-c401t-21f964257890d03cdbd58c523dd3a9470b6a204756f3bab754ba8f75e66f890a3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,777,781,27905,27906</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28250022$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Wong, Charlene A</creatorcontrib><creatorcontrib>Kan, Kristin</creatorcontrib><creatorcontrib>Cidav, Zuleyha</creatorcontrib><creatorcontrib>Nathenson, Robert</creatorcontrib><creatorcontrib>Polsky, Daniel</creatorcontrib><title>Pediatric and Adult Physician Networks in Affordable Care Act Marketplace Plans</title><title>Pediatrics (Evanston)</title><addtitle>Pediatrics</addtitle><description>To describe and compare pediatric and adult specialty physician networks in marketplace plans.
Data on physician networks, including physician specialty and address, in all 2014 individual marketplace silver plans were aggregated. Networks were quantified as the fraction of providers in the underlying rating area within a state that participated in the network. Narrow networks included none available networks (ie, no providers available in the underlying area) and limited networks (ie, included <10% of the available providers in the underlying area). Proportions of narrow networks between pediatric and adult specialty providers were compared.
Among the 1836 unique silver plan networks, the proportions of narrow networks were greater for pediatric (65.9%) than adult specialty (34.9%) networks (
< .001 for all specialties). Specialties with the highest proportion of narrow networks for children were infectious disease (77.4%) and nephrology (74.0%), and they were highest for adults in psychiatry (49.8%) and endocrinology (40.8%). A larger proportion of pediatric networks (43.8%) had no available specialists in the underlying area when compared with adult networks (10.4%) (
< .001 for all specialties). Among networks with available specialists in the underlying area, a higher proportion of pediatric (39.3%) than adult (27.3%) specialist networks were limited (
< .001 except psychiatry).
Narrow networks were more prevalent among pediatric than adult specialists, because of both the sparseness of pediatric specialists and their exclusion from networks. Understanding narrow networks and marketplace network adequacy standards is a necessary beginning to monitor access to care for children and families.</description><subject>Adult</subject><subject>Adults</subject><subject>Child</subject><subject>Company business management</subject><subject>Health Insurance Exchanges - statistics & numerical data</subject><subject>Health Services Accessibility - statistics & numerical data</subject><subject>Humans</subject><subject>Management</subject><subject>Marketplaces</subject><subject>Patient Protection & Affordable Care Act 2010-US</subject><subject>Patient Protection and Affordable Care Act - statistics & numerical data</subject><subject>Pediatrics</subject><subject>Physicians</subject><subject>Physicians - statistics & numerical data</subject><subject>Practice</subject><subject>United States</subject><issn>0031-4005</issn><issn>1098-4275</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkU1v1DAQQC1ERZeFK0dkiQuXbMdfcXKMVuVDKuweytly7ElJ600W2xH039erLRyQRprLm9GTHiHvGGyYkvzqiD5tOLC6EozpF2TFoG0qybV6SVYAglUSQF2S1yndA4BUmr8il7zhCoDzFdnt0Y82x9FRO3na-SVkuv_5mEY32ol-x_x7jg-JjhPthmGO3vYB6dZGpJ3L9JuND5iPwTqk-2Cn9IZcDDYkfPu81-THp-vb7ZfqZvf567a7qZwElivOhraWXOmmBQ_C-d6rxikuvBe2lRr62nKQWtWD6G2vlextM2iFdT2UEyvW5OP57zHOvxZM2RzG5DAUB5yXZFijheaggBf0w3_o_bzEqdgVqgVoaqFVoaozdWcDmnFy85TxT3ZzCHiHpshvd6aTbdMoEGXWZHPmXZxTijiYYxwPNj4aBuaUxpzSmFMac0pTDt4_ayz9Af0__G8L8QRVq4bn</recordid><startdate>201704</startdate><enddate>201704</enddate><creator>Wong, Charlene A</creator><creator>Kan, Kristin</creator><creator>Cidav, Zuleyha</creator><creator>Nathenson, Robert</creator><creator>Polsky, Daniel</creator><general>American Academy of Pediatrics</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7TS</scope><scope>7U9</scope><scope>H94</scope><scope>K9.</scope><scope>M7N</scope><scope>NAPCQ</scope><scope>U9A</scope><scope>7X8</scope></search><sort><creationdate>201704</creationdate><title>Pediatric and Adult Physician Networks in Affordable Care Act Marketplace Plans</title><author>Wong, Charlene A ; Kan, Kristin ; Cidav, Zuleyha ; Nathenson, Robert ; Polsky, Daniel</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c401t-21f964257890d03cdbd58c523dd3a9470b6a204756f3bab754ba8f75e66f890a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Adult</topic><topic>Adults</topic><topic>Child</topic><topic>Company business management</topic><topic>Health Insurance Exchanges - statistics & numerical data</topic><topic>Health Services Accessibility - statistics & numerical data</topic><topic>Humans</topic><topic>Management</topic><topic>Marketplaces</topic><topic>Patient Protection & Affordable Care Act 2010-US</topic><topic>Patient Protection and Affordable Care Act - statistics & numerical data</topic><topic>Pediatrics</topic><topic>Physicians</topic><topic>Physicians - statistics & numerical data</topic><topic>Practice</topic><topic>United States</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Wong, Charlene A</creatorcontrib><creatorcontrib>Kan, Kristin</creatorcontrib><creatorcontrib>Cidav, Zuleyha</creatorcontrib><creatorcontrib>Nathenson, Robert</creatorcontrib><creatorcontrib>Polsky, Daniel</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Physical Education Index</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Pediatrics (Evanston)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Wong, Charlene A</au><au>Kan, Kristin</au><au>Cidav, Zuleyha</au><au>Nathenson, Robert</au><au>Polsky, Daniel</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Pediatric and Adult Physician Networks in Affordable Care Act Marketplace Plans</atitle><jtitle>Pediatrics (Evanston)</jtitle><addtitle>Pediatrics</addtitle><date>2017-04</date><risdate>2017</risdate><volume>139</volume><issue>4</issue><spage>1</spage><pages>1-</pages><issn>0031-4005</issn><eissn>1098-4275</eissn><coden>PEDIAU</coden><abstract>To describe and compare pediatric and adult specialty physician networks in marketplace plans.
Data on physician networks, including physician specialty and address, in all 2014 individual marketplace silver plans were aggregated. Networks were quantified as the fraction of providers in the underlying rating area within a state that participated in the network. Narrow networks included none available networks (ie, no providers available in the underlying area) and limited networks (ie, included <10% of the available providers in the underlying area). Proportions of narrow networks between pediatric and adult specialty providers were compared.
Among the 1836 unique silver plan networks, the proportions of narrow networks were greater for pediatric (65.9%) than adult specialty (34.9%) networks (
< .001 for all specialties). Specialties with the highest proportion of narrow networks for children were infectious disease (77.4%) and nephrology (74.0%), and they were highest for adults in psychiatry (49.8%) and endocrinology (40.8%). A larger proportion of pediatric networks (43.8%) had no available specialists in the underlying area when compared with adult networks (10.4%) (
< .001 for all specialties). Among networks with available specialists in the underlying area, a higher proportion of pediatric (39.3%) than adult (27.3%) specialist networks were limited (
< .001 except psychiatry).
Narrow networks were more prevalent among pediatric than adult specialists, because of both the sparseness of pediatric specialists and their exclusion from networks. Understanding narrow networks and marketplace network adequacy standards is a necessary beginning to monitor access to care for children and families.</abstract><cop>United States</cop><pub>American Academy of Pediatrics</pub><pmid>28250022</pmid><doi>10.1542/peds.2016-3117</doi><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Alma/SFX Local Collection |
| subjects | Adult Adults Child Company business management Health Insurance Exchanges - statistics & numerical data Health Services Accessibility - statistics & numerical data Humans Management Marketplaces Patient Protection & Affordable Care Act 2010-US Patient Protection and Affordable Care Act - statistics & numerical data Pediatrics Physicians Physicians - statistics & numerical data Practice United States |
| title | Pediatric and Adult Physician Networks in Affordable Care Act Marketplace Plans |
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