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Erschienen in: Journal of General Internal Medicine 4/2011

01.04.2011 | Health Policy

The Impact of Health Plan Physician-Tiering on Access to Care

verfasst von: Sean Tackett, BS, Chuck Stelzner, BS, Elizabeth McGlynn, PhD, Ateev Mehrotra, MD, MPH

Erschienen in: Journal of General Internal Medicine | Ausgabe 4/2011

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ABSTRACT

BACKGROUND

In an attempt to improve quality and control costs, health plans are creating tiered products that encourage enrollees to seek care from “high-value” physicians. However, tiered products may limit access to care because patients may have to travel unreasonable distances to visit the nearest high-value physician.

OBJECTIVE

To assess geographic access to high-value physicians, particularly for disadvantaged populations.

DESIGN

Cross-sectional observational study.

PARTICIPANTS

Physicians and adult patients in Massachusetts.

MAIN MEASURES

Travel time from census block centroid to nearest physician address under two scenarios: patients can see (1) any physician or (2) only high-value physicians.

KEY RESULTS

Among the physicians, 768 (20.9%) primary care physicians (PCPs), 225 (26.6%) obstetricians/gynecologists, 69 (10.3%) cardiologists, and 31 (6.0%) general surgeons met the definition of high-value. Statewide mean travel times to the nearest PCP, obstetrician/gynecologist, cardiologist, or general surgeon under the two scenarios (any physician vs. only high-value physicians) were 2.8 vs. 4.8, 6.0 vs. 7.2, 7.0 vs. 12.4, and 6.6 vs. 14.8 minutes, respectively. Across the four specialties, between 89.4%–99.4% of the population lived within 30 minutes of the nearest high-value physician. Rural populations had considerably longer travel times to see high-value physicians, but other disadvantaged populations generally had shorter travel times than comparison groups.

CONCLUSIONS

Most patients in Massachusetts are likely to have reasonable geographic access to high-value physicians in tiered health plans. However, local demographics, especially rural residence, should be taken into consideration when applying tiered health plans broadly. Future work should investigate whether patients can and will switch to receive care from high-value physicians.
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Metadaten
Titel
The Impact of Health Plan Physician-Tiering on Access to Care
verfasst von
Sean Tackett, BS
Chuck Stelzner, BS
Elizabeth McGlynn, PhD
Ateev Mehrotra, MD, MPH
Publikationsdatum
01.04.2011
Verlag
Springer-Verlag
Erschienen in
Journal of General Internal Medicine / Ausgabe 4/2011
Print ISSN: 0884-8734
Elektronische ISSN: 1525-1497
DOI
https://doi.org/10.1007/s11606-010-1607-3

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