Cancer patients may not be able to access the very best of care because of narrowing networks provided by health insurance companies, a new study has found.
Insurance coverage often is limited to certain limits the facilities cancer patients can use and which doctors can treat them. In a University of Pennsylvania study, the authors looked at those coverage networks to find out which how many plans offered on the individual exchanges allowed patients to use top level cancer treatment centers in the country.
And the authors found that 13 percent of plans on those exchanges where National Cancer Institute-designated facilities are located specifically barred patients from using doctors at those centers.
Those institutes are recognized as the best for clinical care and research and tend to be sited in big cities. The country's 69 top centers are located in just 51 of the more than 450 individual exchanges.
Of the 248 networks offered in those 51 markets, 33, or 13 percent, excluded all oncologists from the top cancer centers. Two-thirds of networks in the 51 markets included just under a half of the oncologists who were affiliated with top cancer centers, the study found.
"This study is part of a much larger inquiry looking broadly speaking at how health insurance is evolving, how it expanded under the Affordable Care Act." Professor Dan Polsky, executive director of the University of Pennsylvania’s Leonard Davis Institute of Health Economics and a co-author of the study, told Patient Daily.
"This particular study looks at the relationship of insurance plan providers and whether there is access to fewer doctors – and are they the highest quality doctors," he said.
Polsky said the authors of the study have no opinion as to whether this is a good or bad thing. "Maybe this is fine or that it needs to change," he said.
But, Polsky added, "We must recognize that people on these health plans may not be aware of what they are covered for – until they get cancer. Transparency is an easy one that needs to be fixed."
While the study focused on those markets where the centers are situated, Polsky noted that geography plays a large part when it comes to access to the best care. The top cancer centers are mainly based in urban areas so those living outside of those areas are unlikely to be able to receive treatment at them.
“Narrow networks limit the number of providers within network, leading some enrollees to not be able to see the provider of their choosing or having to pay high out-of-network costs for cancer care," Linda House, president of the Cancer Support Community, said
"In a 2016 Cancer Support Community (CSC) study, we found that 30 percent of respondents listed network adequacy as one of their top concerns related to health insurance and access to care," she said. This means a large number of patients believe their plans do not include access to the facilities and doctors that they might want when it comes to care.
As Congress continues to debate the future of the Affordable Care Act, the University of Pennsylvania study should be a reminder that patients value transparency in health care coverage plans.