RAND Health Insurance Study
This is exactly what makes me hesitant to follow new rules, whatever sphere of life they apply to: new products or new research studies. When they say “Scientists refute the results of the previous study,” I can’t help smiling. That’s what I was waiting for when hesitated to believe their categorical results. I know that as time passes, new views and solutions are bound to be developed and older ideas reconsidered if not altogether denied.
This time it’s RAND study. Now they start questioning whether RAND was wrong. This largest social science experiment has been affecting US health policy for decades. It’s high time to claim it was full of flaws. RAND is all about the cost sharing and its effect on service use, quality of health care, and health of participants.
It’s not only the scientists whose minds are engrossed by the idea of providing all Americans with high quality health care at affordable rates. We all hope it can come true. Higher cost sharing leads to lower levels of medical utilization, and what is more, the lower use of services has no negative health impacts for an average person. This conclusion was made during the experiment which now seems doubtful.
Many participants were randomly assigned to free plans, and others were assigned to some cost-sharing plans. One of the reactions to cost sharing was in a number of RAND participants voluntarily dropping out of the experiment. When they claim that higher co-pays don’t degrade health outcomes, it actually appears that many of those individuals facing health problems and assigned to the high co-pay simply dropped out of the study, which means we don’t know what their outcomes would have been otherwise. Since individuals in the low co-pay group did not drop out of the study, the whole comparison between the two groups is flawed.
This is a classic missing data problem in statistics; they needed to follow up on all the dropouts to get the decent results. So all RAND conclusions were drawn from the biased data and now many studies based on RAND have to be re-viewed too.
Nice.