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RAND Health Insurance Experiment : ウィキペディア英語版 | RAND Health Insurance Experiment The RAND Health Insurance Experiment (RAND HIE) was an experimental study of health care costs, utilization and outcomes in the United States, which assigned people randomly to different kinds of plans and followed their behavior, from 1974 to 1982. As a result, it provided stronger evidence than studies that examine people afterwards who were not randomly assigned. It concluded that cost sharing reduced "inappropriate or unnecessary" medical care (overutilization), but also reduced "appropriate or needed" medical care. It did not have enough statistical power to tell whether people who got less appropriate or needed care were more likely to die as a result. ==Methods==
The RAND HIE was begun in 1971 by a group led by health economist Joseph Newhouse and including health service researchers Robert Brook and John Ware; health economists Willard Manning, Emmett Keeler, Arleen Leibowitz, and Susan Marquis; and statisticians Carl Morris and (Naihua Duan ). The group set out to answer this question (among others): "Does free medical care lead to better health than insurance plans that require the patient to shoulder part of the cost?".〔Brook RH, Ware JE, Rogers WH, Keeler EB, Davies AR, Sherbourne CA, et al. (The effect of coinsurance on the health of adults. Results from the RAND Health Insurance Experiment. ) Santa Monica, CA: RAND Corporation, 1984. Report R-3055-HHS. ISBN 0-8330-0614-2. (earlier version of the present report appeared in the December 8, 1983, issue of ''The New England Journal of Medicine'' (Vol. 309, pp. 1426-1434)." )〕 The team established an insurance company using funding from the then-United States Department of Health, Education, and Welfare. The company randomly assigned 5809 people to insurance plans that either had no cost-sharing, 25%, 50% or 95% coinsurance rates with a maximum annual payment of $1000.〔Manning WG, Newhouse JP, Duan N, Keeler EB, Benjamin B, Liebowitz A, et al. (Health insurance and the demand for medical care. Evidence from a randomized experiment. ) Santa Monica, CA: RAND Corporation, 1988. Report R-3476-HHS. ISBN 0-8330-0864-1. (abridged version of this report... was published in ''The American Economic Review'', June 1987." )〕 It also randomly assigned 1,149 persons to a staff model health maintenance organization (HMO), the Group Health Cooperative of Puget Sound.〔Manning WG, Liebowitz A, Goldberg GA, Newhouse JP, Rogers WH. (A controlled trial of the effect of a prepaid group practice on the utilization of medical services. ) Santa Monica, CA: RAND Corporation, 1985. Report R-3029-HHS. ISBN 0-8330-0679-7. (abridged version of this report was published in the ''New England Journal of Medicine'', June 7, 1984." )〕〔Wagner EH, Bledsoe T. (The Rand Health Insurance Experiment and HMOs. ) Med Care 1990;28:191-200.〕 That group faced no cost sharing and was compared with those in the fee-for-service system with no cost sharing as well as an additional 733 members of the Cooperative who were already enrolled in it.〔
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