A knotty problem: Consumer access and the regulation of provider networks

Simon F. Haeder, David L. Weimer, Dana B. Mukamel

Research output: Contribution to journalArticlepeer-review

20 Scopus citations


In order to increase access to medical services, expanding coverage has long been the preferred solution of policy makers and advocates alike. The calculus appeared straightforward: provide individuals with insurance, and they will be able to see a provider when needed. However, this line of thinking overlooks a crucial intermediary step: provider networks. As provider networks offered by health insurers link available medical services to insurance coverage, their breadth mediates access to health care. Yet the regulation of provider networks is technically, logistically, and normatively complex. What does network regulation currently look like and what should it look like in the future? We take inventory of the ways private and public entities regulate provider networks. Variation across insurance programs and products is truly remarkable, not grounded in empirical justification, and at times inherently absurd. We argue that regulators should be pragmatic and focus on plausible policy levers. These include assuring network accuracy, transparency for consumers, and consumer protections from grievous inadequacies. Ultimately, government regulation provides an important foundation for ensuring minimum levels of access and providing consumers with meaningful information. Yet, information is only truly empowering if consumers can exercise at least some choice in balancing costs, access, and quality.

Original languageEnglish (US)
Pages (from-to)937-954
Number of pages18
JournalJournal of health politics, policy and law
Issue number6
StatePublished - 2019

All Science Journal Classification (ASJC) codes

  • Health Policy


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