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January 27, 1984

Use of Medical Service

Author Affiliations

State University of New York at Stony Brook

JAMA. 1984;251(4):468. doi:10.1001/jama.1984.03340280024009

To the Editor.—  In their article, "How Cost Sharing Reduced Medical Spending," Drs Keeler and Rolph1 have shown elegantly and at great expense that persons who are provided with medical care entirely free of cost at the time of service will use more service than persons whose care is not entirely free—in the early years of that state of grace. Drs Keeler and Rolph do not tell us what the preexperiment insurance status was of any of the participants in their study. However, since few persons in the United States other than health maintenance organization members have entirely free medical care, it is unlikely that more than a few of the subjects of this experiment did so before they entered it. Thus, the Keeler-Rolph study, and possibly the whole Rand Insurance Study, tells no more than we already know from the British National Health Service experience and, indeed, our