Laura Yasaitis, PhD, Justin E. Bekelman, MD, and Daniel Polsky, PhD
PHILADELPHIA – Cancer patients in the United States may be unable to access care at the nation’s top hospitals due to narrow insurance plan coverage – leaving patients to choose between lower premiums or access to higher-quality cancer care. A new study from the Perelman School of Medicine at the University of Pennsylvania
shows common, so-called “narrow network” insurance plans – lower-premium plans with reduced access to certain providers – are more likely to exclude doctors associated with National Cancer Institute (NCI)-Designated Cancer Centers. Researchers published their findings
this week in the Journal of Clinical Oncology
and call for greater access for patients and more transparency from insurers.
“Because cancer care and monitoring is costly, there are strong incentives for insurers to be selective when it comes to oncologists, excluding those who are most likely to attract the most complex and expensive cases,” said the study’s lead author Laura Yasaitis, PhD, a postdoctoral researcher at Penn’s Leonard Davis Institute of Health Economics.
“Consumers may benefit financially from the fact that these narrow networks generally have lower premiums, but they may face reduced access to the higher-quality providers in their market,” added Daniel Polsky, PhD, the executive director of the Leonard Davis Institute of Health Economics and the study’s co-senior author.
The study authors examined cancer provider networks offered on the 2014 individual health insurance exchanges and then determined which oncologists were affiliated with NCI-Designated Cancer Centers or National Comprehensive Cancer Network (NCCN) Cancer Centers. These cancer hospitals are recognized for their scientific and research leadership, quality and safety initiatives, and access to expert physicians and clinical trials. NCCN Member Institutions are particularly recognized for higher-quality care, and treatment at NCI-Designated Cancer Centers is associated with lower mortality than other hospitals, particularly among more severely ill patients and those with more advanced disease. Narrower networks were less likely to include physicians associated with NCI-Designated and NCCN Member Institutions.
“To see such a robust result was surprising,” Yasaitis said. “The finding that narrower networks were more likely to exclude NCI and NCCN oncologists was consistent no matter how we looked at it. This is not just a few networks. It’s a clear trend.”
Researchers said the results point to two major problems: Transparency and access.
“Patients should be able to easily figure out whether the physicians they might need will be covered under a given plan,” said the study’s co-senior author Justin E. Bekelman, MD, an associate professor of Radiation Oncology and Medical Ethics and Health Policy, and a senior fellow in the Leonard Davis Institute for Health Economics. The authors suggest that insurers report doctor’s affiliations with NCI and NCCN Cancer Centers so that consumers can make more informed choices.
The authors also suggest that insurers offer mechanisms that would allow patients to seek care out of network without incurring penalties in exceptional circumstances. “If patients have narrow network plans and absolutely need the kind of complex cancer care that they can only receive from one of these providers, there should be a standard exception process to allow patients to access the care they need,” Bekelman said.
This study was supported by the National Cancer Institute (P30-CA016520, K07-CA163616), the American Cancer Society (RSGI-12697), and the National Institute on Aging (PO1 AG19783).
Penn Medicine is one of the world's leading academic medical centers, dedicated to the related missions of medical education, biomedical research, and excellence in patient care. Penn Medicine consists of the Raymond and Ruth Perelman School of Medicine at the University of Pennsylvania (founded in 1765 as the nation's first medical school) and the University of Pennsylvania Health System, which together form a $6.7 billion enterprise.
The Perelman School of Medicine has been ranked among the top five medical schools in the United States for the past 20 years, according to U.S. News & World Report's survey of research-oriented medical schools. The School is consistently among the nation's top recipients of funding from the National Institutes of Health, with $392 million awarded in the 2016 fiscal year.
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Penn Medicine is committed to improving lives and health through a variety of community-based programs and activities. In fiscal year 2016, Penn Medicine provided $393 million to benefit our community.