Abstract
Health insurers alter the size of their networks, offering lower premiums in exchange for a more limited set of care choices. However, little is known about the association of network size with health care utilization and outcomes, particularly outside of the context of private insurance plans. To evaluate changes in health care utilization after an expansion in the Veterans Affairs Health Care System (VA) health care network. This cross-sectional study included individuals enrolled in the VA from 2015 to 2018. Considering that the health care network expansion only affected a portion of enrollees, only those who lived between 20 and 60 miles from a VA facility were included. Data analysis was conducted from September 2020 to February 2021. Individuals who lived 40 or more miles away from a VA facility were automatically eligible for an expanded health care network through non-VA practitioners (VA community care); those living less than 40 miles away from a VA facility were not automatically eligible. A regression discontinuity analysis of individuals who became eligible for an expanded network based on geographic residence was performed. Inpatient and outpatient utilization rates per VA enrollee during the study period, with utilization differentiated by whether services were provided by a VA or non-VA practitioner, were calculated. The study included more than 2.7 million unique individuals whose characteristics largely reflected the demographic characteristics of the VA system (mean [SD] age, 62 [17] years; 2 589 252 [90%] men; 282 168 [10%] Black; 2 203 352 [77%] White). Patient characteristics (age, race, and comorbidities) did not vary significantly by eligibility status. Outpatient utilization was 3.2% higher (95% CI, 1.0% to 5.3%) among those with access to an expanded network. Increased utilization was most pronounced among those with a higher VA disability rating (3.1%; 95% CI, 0.5% to 5.7%) and among younger individuals without service-connected disabilities (7.0%, 95% CI, 1.7% to 12.3%). There was no evidence of changes to inpatient utilization (1.2%; 95% CI. -2.5% to 4.9%; P = .37) for those with access to the expanded network. In this study, expanded network access was associated with increased total health care utilization among affected enrollees in the VA. Understanding how network size affects utilization is immediately informative for the VA, but it can also help to guide policies for insurance markets.
Highlights
Health insurers use selective contracting to create a network of clinicians, hospitals, and health care systems.[1,2] Creating narrow networks can lead to decreases in utilization, which results in lower costs.[3]
In this study, expanded network access was associated with increased total health care utilization among affected enrollees in the Veterans Affairs (VA)
Understanding how network size affects utilization is immediately informative for the VA, but it can help to guide policies for insurance markets
Summary
Health insurers use selective contracting to create a network of clinicians, hospitals, and health care systems.[1,2] Creating narrow networks can lead to decreases in utilization, which results in lower costs.[3]. When faced with an option to join a narrow network with lower premiums, many individuals are willing to pay higher premiums to maintain continuity with their clinicians.[6,7] Those who choose an insurance plan with a narrow network may see lower premiums and expenditures, but it can leave them with fewer within-network options. For these individuals, narrow networks can become costly, both by way of increased immediate financial costs if they visit out-of-network practitioners and by way of worsened health outcomes due to disruptions in continuity of care or decreased access to care
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
