Attrition in the RAND Health Insurance Experiment: A Response to Nyman
- 1 April 2008
- journal article
- Published by Duke University Press in Journal of Health Politics, Policy and Law
- Vol. 33 (2), 295-308
- https://doi.org/10.1215/03616878-2007-061
Abstract
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.Keywords
This publication has 21 references indexed in Scilit:
- Cost‐Sharing for Emergency Care and Unfavorable Clinical Events: Findings from the Safety and Financial Ramifications of ED Copayments StudyHealth Services Research, 2006
- Estimating the price elasticity of expenditure for prescription drugs in the presence of non‐linear price schedules: an illustration from Quebec, CanadaHealth Economics, 2005
- Neuroeconomics: How Neuroscience Can Inform EconomicsJournal of Economic Literature, 2005
- Co‐payments for prescription drugs and the demand for doctor visits – Evidence from a natural experimentHealth Economics, 2004
- Coping with Unfavorable Attribute Values in ChoiceOrganizational Behavior and Human Decision Processes, 2000
- The Effect of Office Visit Copayments on Utilization in a Health Maintenance OrganizationMedical Care, 1989
- Health status and the demand for health: Results on price elasticitiesJournal of Health Economics, 1988
- Inappropriate Use of Hospitals in a Randomized Trial of Health Insurance PlansNew England Journal of Medicine, 1986
- Health insurance and the demand for medical careJournal of Health Economics, 1983
- Some Interim Results from a Controlled Trial of Cost Sharing in Health InsuranceNew England Journal of Medicine, 1981