Patients with cancer 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. These findings were published by Yasaitis et al in the Journal of Clinical Oncology.
“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 one of the 69 NCI-designated cancer centers or one of the 27 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. There was a significant correlation between a network’s breadth and its relative inclusion of oncologists associated with NCI-designated cancer centers; this relationship held when considering affiliation with NCCN cancer centers only as well. In regions with NCI-designated cancer centers, there were 13.7 oncologists per 100,000 residents and 4.9 networks covering approximately 39.4% of those oncologists, compared with 8.8 oncologists per 100,000 residents and 3.2 networks covering an average of 49.9% of the area’s oncologists (P < .001 for all comparisons).
“To see such a robust result was surprising,” Dr. 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. 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,” concluded 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 content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.