Narrow network health insurance plans have been shown to have lower premiums and lower costs to insurers. This paper decomposes and quantifies the magnitudes for various mechanisms by which networks may reduce premiums and costs. Using data on the Colorado non-group market, we examine three mechanisms through which a narrow network might achieve lower costs: (1) enroll a population with lower utilization, (2) negotiate lower prices, or (3) steer patients away from high-cost hospitals. We find that all three mechanisms play a role. Narrow plans are partly able to achieve lower costs because they both steer patients to lower cost hospitals and, for a given hospital, negotiate lower prices than broad plans. The lower negotiated prices mechanism accounts for 15% of the cost savings to narrow network plans, and the steering away from higher cost hospitals accounts for about 18%. Both of these mechanisms can be ways to efficiently lower costs. The remaining 67% of the cost savings is due to lower utilization of narrow network plan enrollees. These findings are important for policymakers considering how to balance containing healthcare costs with concern for the appropriate regulation of narrow network plans.

中文翻译：

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为什么窄网计划成本更低？

窄网络健康保险计划已被证明具有较低的保费和较低的保险公司成本。本文分解并量化了网络降低保费和成本的各种机制的幅度。使用科罗拉多非团体市场的数据，我们研究了三种机制，通过这些机制，狭窄的网络可能会降低成本：(1) 招募利用率较低的人群，(2) 协商更低的价格，或 (3) 引导患者远离高-成本医院。我们发现这三种机制都起作用。狭义计划在一定程度上能够降低成本，因为它们都将患者引导到成本更低的医院，并且对于给定的医院，谈判价格低于广泛计划。较低的协商价格机制为缩小网络计划节省了 15% 的成本，而远离成本较高的医院约占18%。这两种机制都可以成为有效降低成本的方法。其余 67% 的成本节省是由于窄网络计划登记者的利用率较低。这些发现对于决策者考虑如何在控制医疗成本与对窄网络计划的适当监管之间取得平衡非常重要。