Mixed signals: The inadequacy of provider‐per‐enrollee ratios for assessing network adequacy in California (and elsewhere)

This paper discusses a network-analysis approach to the performance control of integrated built-environment systems based on efficiency, effectiveness, and adequacy. We apply this perspective to the governance of systems of local transport companies in built environments, which are frequently organized as networks. To this end, we propose a multi-dimensional grid of first- and second-order ties to locate network units and individuate the adequacy or appropriateness of network structures for performance control. In this field, issues connected to transport systems such as sustainability play a crucial role in defining structures and processes of network performance control. We empirically examine a pilot case of local public transport companies in the Forlì-Cesena area (Italy), testing network adequacy and giving evidence for the optimal localization of governance among units dedicated to providing transport services. Our results also support the hypothesis that, although structural centralization was ostensibly oriented towards increasing governance, the structure actually devolved into decentralized control at the periphery of the network, diminishing the effectiveness of initiatives.

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Going the Extra Mile? How Provider Network Design Increases Consumer Travel Distance, Particularly for Rural Consumers

Journal of Health Politics Policy and Law ◽

10.1215/03616878-8641591 ◽

2020 ◽

Vol 45 (6) ◽

pp. 1107-1136

Author(s):

Simon F. Haeder ◽

David L. Weimer ◽

Dana B. Mukamel

Keyword(s):

Network Design ◽

Rural Areas ◽

Travel Distance ◽

Open Networks ◽

Provider Network ◽

Network Adequacy ◽

Cardiac Surgeons ◽

Almost All ◽

The Cost ◽

Travel Distances

Abstract Context: The practical accessibility to medical care facilitated by health insurance plans depends not just on the number of providers within their networks but also on distances consumers must travel to reach the providers. Long travel distances inconvenience almost all consumers and may substantially reduce choice and access to providers for some. Methods: The authors assess mean and median travel distances to cardiac surgeons and pediatricians for participants in (1) plans offered through Covered California, (2) comparable commercial plans, and (3) unrestricted open-network plans. The authors repeat the analysis for higher-quality providers. Findings: The authors find that in all areas, but especially in rural areas, Covered California plan subscribers must travel longer than subscribers in the comparable commercial plan; subscribers to either plan must travel substantially longer than consumers in open networks. Analysis of access to higher-quality providers show somewhat larger travel distances. Differences between ACA and commercial plans are generally substantively small. Conclusions: While network design adds travel distance for all consumers, this may be particularly challenging for transportation-disadvantaged populations. As distance is relevant to both health outcomes and the cost of obtaining care, this analysis provides the basis for more appropriate measures of network adequacy than those currently in use.

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