Money Talks: Premium Dollars Trump Network Size for the Uninsured

The February 2014 Kaiser Health Tracking Poll reveals that people who are either uninsured or who purchase their own health insurance would rather save money on premium than spend more to have access to a wider provider network.  The opposite appears to be true for people who obtain their health insurance from their employer.  Although the public at large may prefer “a plan that costs more money but allows you to see a broader range of doctors and hospitals,” when that question was asked to individuals who were either uninsured or who purchase their own insurance, only 35% preferred the more expensive plan.

These findings appear to validate the strategy of employing “narrow network” plans as a mechanism to control costs on one hand, and expand coverage on the other.  Whether quality is maintained, or even enhanced, remains to be seen.  Most commentators seem to suggest that narrow network plans are primarily based upon a model of high-volume, low unit cost.  However, narrow network plans could become important gateways for quality improvement and health improvement.  Providers in those networks would, theoretically, have to be more responsive to demands imposed upon them by their health plans, and those demands could, indeed should, include participation in effective quality improvement programming.

The flip side is, if the provider network is too narrow it can lead to underutilization.  With narrow network plans, insureds must weigh the benefits of the time consuming and gasoline burning trips for appointments that can be miles away.  A cynic would say, that’s part of the business model.

More by | Barry Liss Barry Liss , Law.com Contributor
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