Unbiased Analysis of Today's Healthcare Issues

Physician Access in California Obamacare Plans

Written By: Jason Shafrin - Jul• 27•16

Health plans in the health insurance marketplaces have been competing to keep prices low, while still offering all the services mandated under the Affordable Care Act. One way to do this is to restrict provider networks to lower cost providers.   For patients, restricting provider networks may be a good deal if (i) the quality of care in these restricted networks is good and (ii) they are able to readily access providers when they need them.

To answer the latter question, a paper by Haeder, Weimer, and Mukamel (2016) used a “secret shopper” survey to see how long it would take to make an appointment for primary care services. They compared wait times among health plans both inside and outside of the health insurance exchanges in California. They found that:

…obtaining access to primary care providers was generally equally challenging both inside and outside insurance Marketplaces. In less than 30 percent of cases were consumers able to schedule an appointment with an initially selected physician provider. Information about provider networks was often inaccurate.

Specifically, comparing providers both inside and outside of the Covered California exchanges, the share of providers not accepting new patients (10.2% in market places vs. 10.2% outside the marketplace), unable to reach the provider (18.0% vs. 19.0%), insurance not accepted (4.4% vs. 1.4%) and unable to get an appointment with the original provider (72.7% vs. 70.7%).

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