Health Insurance Flashcards
What is the RAND health insurance experiment?
studied the effects of cost sharing on health care use, quality of care, and health incomes through providing insurance to patients at different rates
What were the cost sharing groups of the RAND HIE
free, 25%, 50%, 95% coinsurance
What were the coinsurance ranges for low income families in the RAND HIE?
5-15%
What were the results for utilization in the RAND HIE?
cost sharing reduced health care utilization; most reductions resulted from not initiating care rather than reducing intensity
What were the results for the effectiveness of care in the RAND HIE?
cost sharing reduced the use of both effective and less effective care
What were the results for quality of care in the RAND HIE?
there were no effects on quality of care
What were benefits seen from the poorest patients in the RAND HIE?
improvements in hypertension, vision care, dental care, and serious symptoms
What are the main takeaways from the RAND HIE?
moral hazard exists and depends on the degree of cost sharing; cost sharing is a blunt tool since it reduces necessary and unnecessary care; cost sharing matters more for lower income individuals
What is the Oregon Health Insurance Experiment?
Oregon selected a fraction of low income uninsured individuals through a lottery of coverage; studied the effects of insurance/expansion of Medicaid
Why was the lottery an important aspect of the Oregon HIE?
allows us to disentangle the “selection” effects; lets us think about those who received insurance and those that are similar but did not win the lottery
What were the details of the RAND HIE?
conducted 1971-1982; large expensive; 2700 families under 65; families participated for 3-5 years
Who was eligible for the Oregon HIE?
OR residents, 19-64 yo, uninsured for 6+ months, income below FPL
How many people signed up for how many slots in Oregon HIE?
90,000 people signed up for 10,000 slots
What were the preliminary findings of the Oregon HIE?
health insurance led to more hospital visits, more procedures, use of rx drugs, outpatient visits, health spending, use of preventative care, less medical debt
