Abstract
Two of the best known randomised trials in health economics are described in detail in this chapter: the RAND Health Insurance Experiment and the Oregon Health Insurance Experiment. The RAND Experiment randomised participants to health insurance plans that varied the cost of care from free care at one extreme to an approximation of a large deductible at the other. Those on the free care plan increased their use of services by about 30% relative to those on the large deductible plan. For the average participant there appeared to be little or no effect on health outcomes from this change in use. Among the poor with hypertension (high blood pressure), however, blood pressure was better controlled on the free care plan, which projected to about a 10% decrease in the risk of mortality. The Oregon Experiment randomised its participants to Medicaid or to remaining uninsured; those with Medicaid insurance used more services and suffered less from depression.
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Ansah, E.K., S. Narh-Bana, S. Asiamah, et al. 2009. Effect of removing direct payment for health care on utilisation and health outcomes in Ghanaian children: A randomised controlled trial. PLoS Medicine 6(1): 48–57.
Aron-Dine, A., L. Einav, and A. Finkelstein. 2013. The RAND Health Insurance Experiment, three decades later. Journal of Economic Perspectives 27(1): 197–222.
Arrow, K.J. 1963. Uncertainty and the welfare economics of medical care. American Economic Review 53(5): 941–73.
Baicker, K., and D.P. Goldman. 2011. Patient cost sharing and health care spending growth. Journal of Economic Perspectives 25(2): 47–68.
Baicker, K., S.L. Taubman, H.L. Allen, et al. 2013. The Oregon Experiment – Effects of Medicaid on clinical outcomes. New England Journal of Medicine 368(18): 1713–22.
Chandra, A., J. Gruber, and R. McKnight. 2010. Patient cost-sharing and hospitalization offsets in the elderly. American Economic Review 100(1): 193–213.
Chandra, A., J. Gruber, and R. McKnight. 2014. The impact of patient cost sharing on the poor: Evidence from Massachusetts. Journal of Health Economics 33: 57–66.
Choudhry, N.K., J. Avorn, R.J. Glynn, et al. 2011. Full coverage for preventive medications after myocardial infarction. New England Journal of Medicine 365(22): 2088–97.
Choudhry, N.K., K. Bykov, W.H. Shrank, et al. 2014. Eliminating medication copayments reduces disparities in cardiovascular care. Health Affairs 33(5): 863–70.
Congressional Budget Office. 2006. Consumer-directed health plans: Potential effects on health care spending and outcomes. Washington, DC: Congressional Budget Office.
Congressional Budget Office. 2010. Selected CBO publications related to health care legislation, 2009–2010. Washington, DC: Congressional Budget Office.
Congressional Budget Office. 2013. Health-related options for reducing the deficit: 2014 to 2023. Washington, DC: Congressional Budget Office.
Cookson, R., and K. Claxton (eds.). 2012. The humble economist: Tony Culyer on health, health care, and social decision making. York: York Publishing Services.
Duan, N., W.G. Manning Jr., C.N. Morris, et al. 1983. A comparison of alternative models of the demand for medical care. Journal of Business and Economic Statistics 1(2): 115–25.
Evans, R.G. 1984. Strained Mercy: The economics of Canadian health care. Toronto: Butterworths.
Finkelstein, A., and S.L. Taubman. 2015. Randomize evaluations to improve health care delivery. Science 347(6223): 720–2.
Finkelstein, A., S. Taubman, B. Wright, et al. 2011. The Oregon Health Insurance Experiment: Evidence from the first year. Cambridge: National Bureau of Economic Research.
Institute of Medicine. 1999. To err is human. Washington, DC: National Academy Press.
Institute of Medicine. 2001. Crossing the quality chasm: A new health system for the 21st century. Washington, DC: National Academy Press.
Manning, W.G., J.P. Newhouse, N. Duan, et al. 1987. Health insurance and the demand for medical care: Results from a randomized experiment. American Economic Review 77(3): 251–77.
Michalopoulos, C., D. Wittenburg, D.A.R. Israel, et al. 2011. The accelerated benefits demonstration and evaluation project: Impacts on health and employment at twelve months. New York: Manpower Demonstration Research Corporation.
Newhouse, J.P., and The Insurance Experiment Group. 1993. Free for all? Lessons from the RAND Health Insurance Experiment. Cambridge: Harvard University Press.
Newhouse, J.P., R.H. Brook, N. Duan, et al. 2008. Attrition in the RAND Health Insurance Experiment: A response to Nyman. Journal of Health Politics, Policy, and Law 33(2): 295–308.
Nyman, J.A. 2007. American health policy: Cracks in the foundation? Journal of Health Politics, Policy, and Law 32(5): 759–83.
Olken, B.A., J. Onishi, and S. Wong. 2011. Indonesia’s PNPM Generasi program: Final impact evaluation report. Washington, DC: The World Bank.
Pauly, M.V. 1968. Comment. American Economic Review 58(3): 531–7.
Powell-Jackson, T., K. Hanson, C.J.M. Whitty, et al. 2014. Who benefits from free healthcare? Evidence from a randomized experiment in Ghana. Journal of Development Economics 107: 305–19.
Rice, T.H. 1998. The economics of health reconsidered. Chicago: Health Administration Press.
Robins, P.K. 1985. A comparison of the labor supply findings from the four negative income tax experiments. Journal of Human Resources 20(4): 567–82.
Rothschild, M., and J. Stiglitz. 1976. Equilibrium in competitive insurance markets: An essay on the economics of imperfect information. Quarterly Journal of Economics 90(4): 629–50.
Sine, J.J. 1994. Demand for episodes of care in the China Health Insurance Experiment. Santa Monica: Rand. Pardee RAND Graduate School.
Taubman, S.L., H.L. Allen, B.J. Wright, et al. 2014. Medicaid increases emergency department use: Evidence from Oregon’s Health Insurance Experiment. Science 343(6168): 263–8.
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Newhouse, J.P. (2018). Use of Experiments in Health Care. In: The New Palgrave Dictionary of Economics. Palgrave Macmillan, London. https://doi.org/10.1057/978-1-349-95189-5_3013
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DOI: https://doi.org/10.1057/978-1-349-95189-5_3013
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