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July 2014

The Downside of Increased Cost Sharing

Author Affiliations
  • 1Center for Pediatric and Adolescent Comparative Effectiveness Research, Indiana University School of Medicine, Indianapolis
  • 2Center for Health Policy and Professionalism Research, Indiana University School of Medicine, Indianapolis
JAMA Pediatr. 2014;168(7):606-607. doi:10.1001/jamapediatrics.2014.449

From 1971 through 1982, the RAND Corporation conducted the most comprehensive randomized clinical trial of health insurance ever performed.1 The investigators randomized more than 2700 families and 7700 individuals to 1 of 5 health insurance plans with different levels of cost sharing. The major finding of the study was that increased cost sharing, or making people pay more out-of-pocket for their care, led people to spend less on health care. They also found that increased cost sharing did not, in general, lead to worse health outcomes.1 Since publication of the RAND Health Insurance Experiment findings, reduced health care spending as a result of increased cost sharing has become an accepted fact. Namely, people are more reluctant to spend their own money than someone else’s.