Provider networks and primary-care signups: do they restrict the use of medical services?
This article analyzes the effect of gatekeeper and network restrictions on use of health-care services using simulation-based estimation methods. Data from the Community Tracking Survey (1996-1997) show significant evidence of selection into plans with gatekeeper and/or network restrictions. Enrollees in plans with networks of physicians have fewer office-based visits to non-physician medical professionals, but more emergency room visits and hospital stays. Individuals in plans that require signups with a primary-care provider have more visits to non-physician providers of care, more surgeries and hospital stays but substantially fewer emergency room visits. Enrollees of plans that do not pay for out-of-network services have more office-based and emergency room visits, but less surgeries and hospitalizations.
Deb
Partha
P
Department of Economics, Hunter College and the Graduate Center, CUNY, New York, NY 10021, USA. partha.deb@hunter.cuny.edu
Trivedi
Pravin K
PK
D005260:Female; D020793:Gatekeeping / Q000458:organization & administration*; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000458:organization & administration*; D006801:Humans; D008297:Male; D008329:Managed Care Programs; D017059:Models, Econometric; D011320:Primary Health Care / Q000706:statistics & numerical data*; D014481:United States