title: Pediatric and Adult Physician Networks in Affordable Care Act Marketplace Plans.
abstract: OBJECTIVE
  To describe and compare pediatric and adult specialty physician networks in marketplace plans.
  
  
  METHODS
  Data on physician networks, including physician specialty and address, in all 2014 individual marketplace silver plans were aggregated. Networks were quantified as the fraction of providers in the underlying rating area within a state that participated in the network. Narrow networks included none available networks (ie, no providers available in the underlying area) and limited networks (ie, included <10% of the available providers in the underlying area). Proportions of narrow networks between pediatric and adult specialty providers were compared.
  
  
  RESULTS
  Among the 1836 unique silver plan networks, the proportions of narrow networks were greater for pediatric (65.9%) than adult specialty (34.9%) networks (P< .001 for all specialties). Specialties with the highest proportion of narrow networks for children were infectious disease (77.4%) and nephrology (74.0%), and they were highest for adults in psychiatry (49.8%) and endocrinology (40.8%). A larger proportion of pediatric networks (43.8%) had no available specialists in the underlying area when compared with adult networks (10.4%) (P< .001 for all specialties). Among networks with available specialists in the underlying area, a higher proportion of pediatric (39.3%) than adult (27.3%) specialist networks were limited (P< .001 except psychiatry).
  
  
  CONCLUSIONS
  Narrow networks were more prevalent among pediatric than adult specialists, because of both the sparseness of pediatric specialists and their exclusion from networks. Understanding narrow networks and marketplace network adequacy standards is a necessary beginning to monitor access to care for children and families.
authors.affiliation: Division of Adolescent Medicine, Department of Pediatrics, The Children's Hospital of Philadelphia.|Leonard Davis Institute of Health Economics, and.
authors.forename: Charlene A
authors.initials: CA
authors.lastname: Wong
authors.affiliation: Robert Wood Johnson Foundation Clinical Scholars Program and kkan@luriechildrens.org.|Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, Michigan.
authors.forename: Kristin
authors.initials: K
authors.lastname: Kan
authors.affiliation: Leonard Davis Institute of Health Economics, and.|Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; and.
authors.forename: Zuleyha
authors.initials: Z
authors.lastname: Cidav
authors.affiliation: Leonard Davis Institute of Health Economics, and.
authors.forename: Robert
authors.initials: R
authors.lastname: Nathenson
authors.affiliation: Leonard Davis Institute of Health Economics, and.
authors.forename: Daniel
authors.initials: D
authors.lastname: Polsky
mesh_terms: D000328:Adult; D002648:Child; D062265:Health Insurance Exchanges / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D058991:Patient Protection and Affordable Care Act / Q000706:statistics & numerical data*; D010820:Physicians / Q000706:statistics & numerical data*; D014481:United States