A study published in the Journal of the American Medical Association shows that access to physicians in some specialized fields is lacking in marketplace plans offered by the Affordable Care Act (ACA).
The study, called "Adequacy of outpatient specialty care access in marketplace plans under the Affordable Care Act," shows that nearly 15 percent of the health care plans within the ACA offerings lack in-network physicians for at least one specialty.
"That was really surprising," lead author Stephen Dorner, a fourth-year student at Vanderbilt University School of Medicine, said. "In theory, this scenario is not supposed to happen based on the way the regulation is written, which states that a sufficient number and type of provider should be contained in the plans to guarantee access to care."
Dorner and his team reviewed insurance plans offered in 34 states through the federal marketplace. Study investigators used the plans' online directories to search for in-network specialty physicians within a 100-mile radius.
"If they have no physicians whatsoever in the network, it seems to me that they are not meeting the standard," he said. "It raises questions about the enforcement of the existing regulations."
Researchers found that endocrinology, rheumatology and psychiatry specialists were the most often lacking out of all specialties studied.
"The major takeaway from this, which is really bad for the patients, is that if they needed access to these specialists -- they do not have it," Dorner said. "This also translates to really high costs for the patient."
