Attrition in the RAND Health Insurance Experiment: a response to Nyman.
نویسندگان
چکیده
In a prior article in this journal, John Nyman argues that the effect on health care use and spending found in the RAND Health Insurance Experiment is an artifact of greater voluntary attrition in the cost-sharing plans relative to the free care plan. Specifically, he speculates that those in the cost-sharing plans, when faced with a hospitalization, withdrew. His argument is implausible because (1) families facing a hospitalization would be worse off financially by withdrawing; (2) a large number of observational studies find a similar effect of cost sharing on use; (3) those who left did not differ in their utilization prior to leaving; (4) if there had been no attrition and cost sharing did not reduce hospitalization rates, each adult in each family that withdrew would have had to have been hospitalized once each year for the duration of time they would otherwise have been in the experiment, an implausibly high rate; (5) there are benign explanations for the higher attrition in the cost-sharing plans. Finally, we obtained follow-up health-status data on the great majority of those who left prematurely. We found the health-status findings were insensitive to the inclusion of the attrition cases.
منابع مشابه
The income transfer effect, the access value of insurance and the Rand health insurance experiment.
Åke Blomqvist (2001) raises the issue of relevance in his review of my two papers (Nyman, 1999a,b). He agrees that because of the skewed distribution in health expenditures (which concentrates most of income transfers from health insurance in the hands of those few who become ill), income transfers explain a large portion of the additional consumption due to becoming insured. Nevertheless, he a...
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ورودعنوان ژورنال:
- Journal of health politics, policy and law
دوره 33 2 شماره
صفحات -
تاریخ انتشار 2008