Narrow-network insurance plans may limit access to high-quality oncologists

Health insurance benefits form
People enrolled in narrow network health plans may pay lower premiums, but they also have limited access to top cancer specialists, according to a new study. (Getty/michaelquirk)

Low-cost, narrow-network health plans are becoming more common, but the limited choice of doctors frequently excludes some of the top cancer physicians in the country, according to a new study.

Researchers at the University of Pennsylvania examined data on more than 23,000 oncologists across the country, looking for how often doctors affiliated with National Cancer Institute-designated facilities were included in narrow provider networks sold in the individual markets. Doctors working at the 69 institute facilities were twice as likely to be excluded from plans with the narrowest networks, according to the study published in the Journal of Clinical Oncology.

Oncologists at those facilities are more likely to have the skills needed to treat advanced or complicated cancer cases.

Free Daily Newsletter

Like this story? Subscribe to FierceHealthcare!

The healthcare sector remains in flux as policy, regulation, technology and trends shape the market. FierceHealthcare subscribers rely on our suite of newsletters as their must-read source for the latest news, analysis and data impacting their world. Sign up today to get healthcare news and updates delivered to your inbox and read on the go.

RELATED: Getting narrow networks right could be the key to coverage expansion

“There are many patients with rare or uncommon tumors who need access to the most advanced clinical trials, and that access is often only at these NCI cancer centers,” Justin Bekelman, associate professor of radiation oncology, medical ethics and health policy at the University of Pennsylvania and one of the study’s authors, told Bloomberg. “On the individual market, when people are spending their own hard-earned dollars, they can chose to have access or not. But right now they are choosing in a blind way.”

RELATED: 3 lessons on regulating health plan network adequacy

The results, the researchers concluded, indicate that people may benefit from the lower premiums that narrow network plans offer, but at the cost of decreased access to some high-quality providers. However, the results may not be applicable to other types of care or to all narrow networks.

The findings, however, indicate that provider networks should be a consideration as Congress continues to debate a repeal of the Affordable Care Act.

“Our findings reaffirm and extend prior calls for accurate information about providers in health plan networks and are relevant to replacement proposals for the Affordable Care Act, which foster shoppable insurance in both the individual and group markets,” the authors said.

Suggested Articles

To build scale and drive greater savings, providers in some regions are banding together in statewide Medicare accountable care organizations. 

CMS issued updated Medicaid guidance on regulations for state-run home and community-based services.

Regulators warn that suggestions to address surprise bills, such as rate setting and payment caps, come with significant downsides for states.