Is this really an issue that surprises anyone? If you are paying for a lower tier of insurance then it makes sense to limit the hospital choices available to you. The whole "I'm going to pay less but still want the same level of care as someone paying a premium" attitude needs to go.
Wal-Mart doesn't think so. They have a program, can't remember if it's still in the trial stage, where they since employees with particular issues to specialist centers, the theory, which they're collecting data on or have confirmed, is that in the long term this results in better outcomes that are cheaper.
There's very strong reasons to believe this for surgery, since the best determinant of success is how many times a surgeon performed a particular procedure.
That's the fallacy right there. Nobody is paying 'less'. The system is absorbing new risk, so service is being cut. I'm not so sure why that's hard to understand. Read the article, and its quite clear the reportage is about incremental exclusions, required to offset "new costs"...
When the Obama administration was asked whether the new healthcare exchanges were offering adequate network options to new consumers, a spokeswoman for the Department of Health and Human Services (HHS) emphasised that the new exchanges would “vastly increase” the access to medical providers to millions of uninsured Americans.
The one area where I wonder about this is Children's hospitals. There's been some stories in Seattle because most of the Washington Health Exchange plans excluded Seattle Children's, which may be a problem for families given that Seattle Children's provides services that other hospitals in the area can't and/or don't.
At least one insurance company in the area has responded by electing to cover unique services provided by Seattle Children's, so that's at least a middle ground.
A book called Catastrophic Care came out recently. It's written by a guy named David Goldhill, who wrote a cover story for The Atlantic in 2009 on broken incentives in the healthcare industry that tend over time to push prices up and quality down. (His unrelated day job is CEO of the Game Show Network.)
The book gets at the problems in the industry on a much deeper level than anything else I've seen.
> "Americans who are buying insurance plans over online exchanges, under what is known as Obamacare, will have limited access to some of the nation’s leading hospitals, including two world-renowned cancer centres."
"Amid a drive by insurers to limit costs, the majority of insurance plans being sold on the new healthcare exchanges in New York, Texas, and California, for example, will not offer patients’ access to Memorial Sloan Kettering in Manhattan or MD Anderson Cancer Center in Houston, two top cancer centres, or Cedars-Sinai in Los Angeles, one of the top research and teaching hospitals in the country."
"Experts say the move by insurers to limit consumers’ choices and steer them away from hospitals that are considered too expensive, or even “inefficient”, reflects the new competitive landscape in the insurance industry since the passage of the Affordable Care Act, Barack Obama’s 2010 healthcare law."
Isn't this the same as existing insurance plans where you have a certain network of doctors or hospitals you have access to, and if you access services out of network, you have to pay?
I guess there is some controversy if insurance companies drop your plan which provides coverage to top hospitals, and you can't find a similar plan on the new exchanges to replace it, and if one does exist you have to pay an arm and a leg for it.
There is the unspoken assumption here, with no evidence to back it up, that the majority of plans not offered on the exchanges before the ACA would cover these hospitals. Unless that was the case, then this is a non-story, as nothing has really changed. Personally I suspect most of the pre-ACA plans considered these out-of-network as well.
