The conversation surrounding healthcare reform has been based almost exclusively on the assumption that improving access to care will ultimately lower cost by bettering health preventively. Testing the validity of that assumption will rely in large part on making that care accessible (read: affordable).
What are the 150 million Americans who receive health insurance through their employer likely to pay for a preventative primary care visit in-network? Healthcare Dive takes a look.
Narrow networks emerged in response to rising costs, and insurers claim that they work well as a high-value way to provide quality care at a lower premium level. According to a recent Milliman study touted by AHIP, narrow provider networks "allow for more affordable coverage options with 5% to 20% lower premiums compared to broader network plans, while placing an emphasis on quality care."
But while narrow networks may help to keep relative premium costs lower, they do not dictate out-of-pocket costs (which across exchange plans, at least, have varied). As a result, the consumer is still at the mercy of the wild variation of prices for healthcare services from city to city, even if they do stay in-network. That variation points to the chief challenge of healthcare reform: How to define and normalize costs across the country to provide affordable access to primary care.
And the variation is extreme: According to a recent study by Castlight Health, getting an MRI of your lower back costs nearly three times more in Sacramento ($2,635) than in Seattle ($907). A primary care doctor visit costs more than twice as much in San Francisco ($251) than in Miami ($95).