The Affordable Care Act has narrowed patient networks in California, but at no overall cost to care quality, according to a new study published in Health Affairs.
Researchers, led by Simon F. Haeder of the University of Wisconsin-Madison, compared the hospital networks available in California to patients with private commercial coverage and those who got coverage through Covered California, the state insurance exchange. When they compared the ratio of hospitals by region to type of plan, they found that on average, Covered California patients had about 20 percent less access to hospitals than those with commercial coverage, and in a series of 58 comparisons, commercial networks had more hospital options than exchanges in 38 cases. Access was greater for exchanges in three cases and equal in the remaining 17.
However, Haeder and his team also found no significant difference between plans in terms of geographical barriers to in-network care. Ninety-two percent of exchange patients were within range of at least one in-network hospital, compared to 93 percent of commercially insured patients.
Moreover, coverage under the exchange did not reduce care quality. In fact, the only analysis that found a disparity indicated care under Covered California was superior, co-author David Weimer said in a statement. These results, he said, suggest payers may be intentionally excluding providers designated as top performers. Moreover, determining care quality can be particularly difficult in California due to regulations that do not identify errors in individual hospitals, FierceHealthcare previously reported.
"Overall, our results suggest that narrower exchange networks do not substantially restrict geographic access and, more importantly, do not reduce access to high quality care compared to the networks of standard commercial plans," Weimer said.
Last year, a report from Moody's Investors Service warned that narrow exchange networks could damage hospital finances in the long term, FierceHealthFinance reported.