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January 27, 1984

Use of Medical Service-Reply

Author Affiliations

The Rand Corporation Santa Monica, Calif

JAMA. 1984;251(4):468. doi:10.1001/jama.1984.03340280024010

In Reply.—  The Health Insurance Experiment showed that people with free medical care use more services. Dr Jonas implies that the increase is temporary and is caused by such people catching up with previously unmet needs. Several results make this unlikely. First, the response to cost sharing was about the same across the three years we have studied. Second, a week-by-week analysis of use shows that people with free care had initial surges only in well and dental care. These surges lasted only 12 weeks and together represented an additional 0.3 episodes per person.1 The tremendous increases in dentures and spectacles supplied in the early years of the British National Health Service were not seen, presumably because there was much less unmet need in the United States in 1976 than in Britain in 1948. Third, chronic and well care episodes (where unmet needs might be expected) were rarer and