To the Editor.—
In a recent article (1983;249:2220), Drs Keeler and Rolph reported a study that revealed that "participants who paid part of their bills had many fewer outpatient episodes of treatment, on average, than those with free care." We are concerned that it is misleading to publish results showing the reduced costs of care from this kind of economic manipulation without comparing or considering the outcome of that care. It is our hope that the Rand Health Insurance Experiment will soon publish information on other variables that influence a patient's decision to seek or delay seeking medical care and the effect of that decision on the quality of health.We recently conducted a randomized study of single-dose v multipledose therapy in 64 women with symptoms of urinary tract infections. Patients were covered by comprehensive prepaid medical insurance (prepaid health plan [PHP]) or a variety of fee-for-service (FFS) methods of
Sneider JS, Thompson CJ. Payment for Medical Care. JAMA. 1983;250(22):3048–3049. doi:10.1001/jama.1983.03340220020020
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