Patients say access to health care is about more than just travel time and being seen quickly

Most health insurance plans in the United States manage costs by financially incentivizing plan members to get health care within a network of health care providers. Insurance regulators issue requirements—called network adequacy standards—to pressure networks to comply with federal or state standards for health care access. These standards include issues such as providing enough health care providers in various specialties within a reasonable distance of plan members.

One major obstacle in ensuring an adequate supply of providers is that the concept of network adequacy is vague, so policymakers have little objective data to guide their decisions.

To help fill this gap, Simon Haeder, PhD, an associate professor of health policy and management in the Texas A&M University School of Public Health, and a colleague at The Ohio State University surveyed a major stakeholder in managed health care: patients.

“Consumers could provide valuable information about which facets of provider networks they believe are important to network adequacy, but until now they had never been asked for their opinions of what an ‘adequate’ network should look like,” Haeder said.

The study, funded by the Robert Wood Johnson Foundation and published in the American Journal of Managed Care, surveyed 4,008 demographically diverse adults in the United States about their perceptions of what adequate provider networks look like in the abstract, including travel time and concepts related to health equity. The survey was conducted from June 30 to July 2, 2023.

Statistical analyses of the responses found strong support for definitions of adequacy related to timely access to primary care (81.9 percent), specialty care (82.6 percent) and mental health care (82.6 percent). Similar support also was expressed for reasonable travel times: primary care (80.5 percent), specialty care (78.6 percent) and mental health care (80.6 percent). Those surveyed defined acceptable travel distances as 26.04 minutes for primary care, 30.34 minutes for specialty care and 27.49 minutes for mental health care.fgn

Most respondents also wanted to broaden network adequacy definitions to include health equity issues such as public transportation access (67.3 percent), cultural competency (57.4 percent) and LGBT+ inclusive care (57.2 percent). Respondents who were women, had higher levels of education, were in worse health, and/or had recent experiences with the medical system expressed more support for these expanded definitions.

“In general, we found that health insurance plan members have broader conceptions of network adequacy than are currently in place,” Haeder said. “That means that additional work is needed to determine what tradeoffs consumers would support given that resources are limited, as well as consumers’ perceptions of providers and carriers.”

The article is part of a broader research project that seeks to increase our understanding about how patients navigate provider networks and what challenges they face in accessing care. Other papers from the portfolio have assessed how states regulate provider networks, what challenges consumers have when using provider directories and how it affects their attitudes about government action, and how long inaccurate entries in provider directories persist.