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And the insurers that remain in these markets tend to offer an increasingly narrow network of health-care providers.
As the police and Swat team returned to their vehicles, the detectives walked among the reeds towards a narrow network of creeks connecting the house to the river.
The narrow network, if it is based on the insurers' ability to demand low prices, may be "just another short-term fix," warned Barry Schilmeister, a consultant at Mercer.
"If a health plan has a narrow network that excludes many doctors, that may shoo away patients with expensive pre-existing conditions who have established relationships with doctors," said Mark E. Rust, the chairman of the national health care practice at Barnes & Thornburg, a law firm.
The process ought to be carefully defined and carried out, not rely on hunches or a narrow network of contacts.
Our results show that narrow network health plans lead to reductions in health care utilization and spending.
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"We were told that insurers would develop narrow networks excluding high-cost providers, and squeeze providers to give lower rates," Mr. Holahan told me.
But many insurers see advantages in narrow networks, saying they can steer patients to less expensive doctors and hospitals that provide high-quality care.
"But the use of narrow networks may also lead to higher out-of-pocket expenses, especially if a patient has a complex medical problem that's being treated at a hospital that has been excluded from their health plan".
We find evidence that narrow networks save money by selecting lower cost providers into the network.
It also highlights growing public anger at "the Westminster bubble" and the "strong sense that democracy in the UK has been 'captured' by narrow networks of powerful but increasingly unaccountable elites".
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Justyna Jupowicz-Kozak
CEO of Professional Science Editing for Scientists @ prosciediting.com