There are a number of ways plans in health insurance marketplace can lower their premiums. One option is to increase cost sharing. Plans in the bronze and sliver tier have much lower premiums than those in the gold and platinum tier. Within any tier, plans can restrict patient access to lower cost providers; this also will reduce cost. It is a common believe that plans in the health insurance exchange marketplaces have narrower networks and lower quality compared to traditional plans. Is this true? A paper by Haeder, Weimer, and Mukamel (2015) find the following:
We found that the common belief that Marketplace plans have narrower networks than their commercial counterparts appears empirically valid. However, there does not appear to be a substantive difference in geographic access as measured by the percentage of people residing in at least one hospital market area. More surprisingly, depending on the measure of hospital quality employed, the Marketplace plans have networks with comparable or even higher average quality than the networks of their commercial counterparts.
One issue is that the researchers measure quality only using the AHRQ quality indicators. While the AHRQ measures do a good job at measuring quality based on mortality and established best practices, they have less insight into whether physicians in the network are more likely to have mastered the latest cutting edge techniques. Nevertheless, it is interesting that plans in the health insurance exchanges appear weakly superior to those outside of the marketplace.
- Simon F. Haeder, David L. Weimer and Dana B. Mukamel. California Hospital Networks Are Narrower In Marketplace Than In Commercial Plans, But Access And Quality Are Similar. Health Affairs, 34, no.5 (2015):741-748.