Networks in ACA marketplaces are narrower for mental health care than for primary care

Jane M. Zhu, Yuehan Zhang, Daniel E. Polsky

Research output: Contribution to journalArticle

Abstract

There is increasing concern about the extent to which narrow-network plans, generally defined as those including fewer than 25 percent of providers in a given health insurance market, affect consumers' choice of and access to specialty providers-particularly in mental health care. Using data for 2016 from 531 unique provider networks in the Affordable Care Act Marketplaces, we evaluated how network size and the percentage of providers who participate in any network differ between mental health care providers and a control group of primary care providers. Compared to primary care networks, participation in mental health networks was low, with only 42.7 percent of psychiatrists and 19.3 percent of nonphysician mental health care providers participating in any network. On average, plan networks included 24.3 percent of all primary care providers and 11.3 percent of all mental health care providers practicing in a given state-level market. These findings raise important questions about provider-side barriers to meeting the goal of mental health parity regulations: that insurers cover mental health services on a par with general medical and surgical services. Concerted efforts to increase network participation by mental health care providers, along with greater regulatory attention to network size and composition, could improve consumer choice and complement efforts to achieve mental health parity.

Original languageEnglish (US)
Pages (from-to)1624-1631
Number of pages8
JournalHealth Affairs
Volume36
Issue number9
DOIs
StatePublished - Sep 1 2017
Externally publishedYes

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Primary Health Care
Mental Health
Delivery of Health Care
Health Personnel
Parity
Patient Protection and Affordable Care Act
Insurance Carriers
Mental Health Services
Health Insurance
Psychiatry
Control Groups

ASJC Scopus subject areas

  • Health Policy

Cite this

Networks in ACA marketplaces are narrower for mental health care than for primary care. / Zhu, Jane M.; Zhang, Yuehan; Polsky, Daniel E.

In: Health Affairs, Vol. 36, No. 9, 01.09.2017, p. 1624-1631.

Research output: Contribution to journalArticle

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