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Free for All?
In the most important health insurance study ever conducted researchers at the RAND Corporation devised all experiment to address two key questions in health care financing: how much more medical care will people use if it is provided free of charge, and what are the consequences for their health? For three- or five-year periods the experiment measured both use and health outcomes in populations carefully selected to be representative of both urban and rural regions throughout the United States. Participants were enrolled in a range of insurance plans requiring different levels of copayment for medical care, from zero to 95 percent. The researchers found that in plans that reimbursed a highe...
Use of Medical Care in the Rand Health Insurance Experiment
This monograph presents studies from the Rand Health Insurance Experiment (HIE) concerning the effect of cost-sharing on the use of outpatient medical care for specific diagnosis. The HIE was a large-scale randomized controlled trial of alternative forms of health care financing sponsored by the U.S. Departement of Health and Human Services. The study took place between Nov. 1974 and Janv. 1982 in six sites in the United States and enrolled more than 7'700 nonaged persons in one of several experimental health insurance plans. These analyzes highlight the effect of cost-sharing on the probability of using medical care for specific diagnoses or problems, and the content of medical practice ("disease profile") for specific conditions or reasons for seeking care. Appendixes : Definitions of Groups of diagnoses, procedures and test, and drugs. Rules for creating episodes of care from HIE claims data. Observed probabilities of an episode of care. Logistic regressions. Episode size for selected diagnoses by plan.
The Health Insurance Experiment
This research brief summarizes the main findings of the RAND Health Insurance Experiment and clarifies its relevance for today's health care debate.
Rand Report
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Sample Selection in the Health Insurance Experiment
The Rand Health Insurance Experiment (HIE) included a controlled trial of cost sharing in health insurance to determine the relative effects of various benefits on health service utilization, health status, oand other factors. Such analyses require that the different cost-sharing benefits be applied to similar populations, so that any nonrandom differences in responses can be attributed solely to the differences in benefits. This Note establishes the similarity with respect to preexperimental baseline survey data of the HIE populations, at the time of initial enrollment in alternative cost-sharing medical insurance plans, to the nonenrolled population. These results encourage confidence in extrapolating estimates made from experimental samples to larger populations. [Author]
A Controlled Trial of the Effect of a Prepaid Group Practice on the Utilization of Medical Services
Does a prepaid group practice deliver less care than the fee -for service system when both serve comparable populations with comparable benefits? To answer this question, we randomly assigned a group of 1580 persons to receive care free of charge either from a fee-forservice physician of their choice (431 persons) or at the Group Health Cooperative of Puget Sound, or GHC (1149 persons). Another 733 prior enrollees of the GHC were studied as a control. Additionally, 782 persons who shared in the cost of their fee -for -service care, but were otherwise comparable to the first two groups, were studied to observe the effects of cost sharing. The rate of hospital admissions for both groups at GHC was about 40 percent less than in the free-care fee-for -service group (p
