Commercial Insurer Market Power and Medicaid Managed Care Networks.

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  • Additional Information
    • Source:
      Publisher: Sage Periodicals Press Country of Publication: United States NLM ID: 9506850 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1552-6801 (Electronic) Linking ISSN: 10775587 NLM ISO Abbreviation: Med Care Res Rev Subsets: MEDLINE
    • Publication Information:
      Original Publication: Thousand Oaks, CA : Sage Periodicals Press, c1995-
    • Subject Terms:
      Medicaid*/statistics & numerical data ; Medicaid*/economics ; Managed Care Programs*/economics ; Managed Care Programs*/statistics & numerical data ; Managed Care Programs*/organization & administration ; Insurance, Health*/economics ; Insurance, Health*/statistics & numerical data; United States ; Humans ; Health Services Accessibility/statistics & numerical data ; Insurance Carriers/economics ; Insurance Carriers/statistics & numerical data
    • Abstract:
      Over 70% of Medicaid beneficiaries are enrolled in Medicaid managed care (MMC). MMC provider networks therefore represent a critical determinant of access to the Medicaid program. Many MMC insurers also participate in commercial insurance markets where prices are high, and some insurers exercise considerable market power. In this paper, we examined the relationship between commercial insurer market power and MMC physician network breadth using linked national enrollment data and provider directory data. Insurers with more commercial market power had broader Medicaid physician networks. Insurers with over 30% market share had 37.3% broader Medicaid networks than insurers in the same county that had no commercial market share. These differences were driven by greater breadth among primary care providers, as well as other specialists including OB/GYNs, surgeons, neurologists, and cardiologists. Commercial insurance market power may have spillovers on access to care for MMC beneficiaries.
      Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
    • Contributed Indexing:
      Keywords: Medicaid; Medicaid managed care; health insurance
    • Publication Date:
      Date Created: 20240405 Date Completed: 20240730 Latest Revision: 20240730
    • Publication Date:
      20240730
    • Accession Number:
      10.1177/10775587241241975
    • Accession Number:
      38577807