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Consumer cost-sharing in health insurance is advocated by some as a means of containing rising health care costs. There is strong evidence that cost-sharing reduces the quantity of medical care demanded. Cost-sharing, it is argued, also may encourage consumers to search for lower-priced providers of care which, in turn, would encourage price competition among physicians as they try to attract or retain patients. This report analyzes two measures of choice of provider: a categorical variable representing the specialty type of provider from which the patient sought care, and a variable measuring the relative costliness or prices of the chosen provider. The author concludes that the preliminary results provide scant reason to believe that cost-sharing will lead consumers to search for lower-cost providers of care and thereby enhance the competitiveness of the medical market.
Medical care --- Medical care --- Health insurance --- Health insurance --- Medical fees --- Medical fees --- Cost control. --- Cost control. --- Finance. --- Finance.
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Does free medical care lead to better health than insurance plans that require the patient to shoulder part of the cost? In an effort to answer this question, the authors studied 3,958 people between the ages of 14 and 61 who were free of disability that precluded work and had been randomly assigned to a set of insurance plans for three or five years. One plan provided free care; the others required enrollees to pay a share of their medical bills. As reported in R-2847-HHS, patients in the latter group made approximately one-third fewer visits to a physician and were hospitalized about one-third less often. For persons with poor vision and for low-income persons with high blood pressure, free care brought an improvement (vision better by 0.2 Snellen lines, diastolic blood pressure lower by 3 mm Hg); better control of blood pressure reduced the calculated risk of early death among those at high risk. For the average participant, as well as for subgroups differing in income and initial health status, no significant effects were detected on eight other measures of health status and health habits. Confidence intervals for these eight measures were sufficiently narrow to rule out all but a minimal influence, favorable or adverse, of free care for the average participant. For some measures of health in subgroups of the population, however, the broader confidence intervals make this conclusion less certain.
Health surveys --- Medical care --- Medical care, Cost of --- Health coinsurance --- Health Surveys --- Insurance, Health --- Utilization --- Rand Health Insurance Experiment.
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