1. RAND Health Insurance Experiment

2.  Involved 2,000 non-elderly families  6 US cities  From 1974 -1982 for 3 - 5 years each  Randomized subjects into various health plans with payments ranging between 0% - 95%

3.  To study the effect of cost sharing on  Service Use  Quality of Care  Health Status

4. Plan VariablesPlan 1 Plan 2, 3, 4 Plan 5, 6, 7 Plan 8, 9, 10 Plan 11, 12, 13 Plan 14 Amount of Co- insurance 025%50%95%25%95% Out-Patient 0% In-Patient Maximum Dollar Expenditure of Family income 0Options: 5%, 10%, 15% Options: 5%, 10%, 15% Options: 5%, 10%, 15% Options: 5%, 10%, 15% $150 per individual Maximum Payment0$1000 $450 per family Exempt Services----Mental Health & Dental -

6.  No net adverse effect on health  No significant differences in the risk of dying, measures of pain, or worry  Poor and sick poor were severely affected mortality rates blood pressure

7. Increase in Co-insurance rate People pay more they reach the MDE faster more will have access to free care People pay more for health services they use it less

8.  Canada  Czech Republic  Denmark  Netherlands  Spain  United Kingdom