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Kullgren et al1 show that low-income families with high-deductible health plans report cost-related delayed or foregone care. However, the authors fail to show that the additional care consumed by the higher-income group was essential or that outcomes were superior in that group.
In the well-known RAND study of free medical care vs cost sharing,2 the cost sharing group had one-third fewer ambulatory visits and one-third fewer hospitalizations than the free-care group, and yet there was no difference in health measures between either group for the average patient except for a trivial difference in corrected vision of 20/22 vs 20/22.5. In the subgroup of low-income high-risk patients, there was a significant 3.3 mm Hg difference in diastolic blood pressure, but there was no difference in smoking, weight, cholesterol level, or any of 5 self-assessed measures of health.
Erlebacher J. More Health Care Is Not Necessarily Better Health Care. Arch Intern Med. 2011;171(12):1124. doi:10.1001/archinternmed.2011.268