Leibowitz A, Manning W G, Keeler E B, Duan N, Lohr K N, Newhouse J P
Pediatrics. 1985 May;75(5):942-51.
Health care expenditures of 1,136 children whose families participated in a randomized trial, The Rand Health Insurance Experiment, are reported. Children whose families were assigned to receive 100% reimbursement for health costs spent one third more per capita than children whose families paid 95% of medical expenses up to a family maximum. Outpatient use decreased as cost-sharing rose for a variety of use measures: the probability of seeing a doctor, annual expenditures, number of visits per year, and numbers of outpatient treatment episodes. Hospital expenditures did not vary significantly among children insured with varying levels of cost-sharing. Episodes of treatment for preventive care were as responsive to cost-sharing as episodes for acute or chronic illness. The results give no reason not to insure preventive care as liberally as care for acute illness.
报告了1136名儿童的医疗保健支出情况，这些儿童的家庭参与了一项随机试验——兰德健康保险试验。家庭被指定获得医疗费用100%报销的儿童，其人均支出比家庭支付高达家庭上限95%医疗费用的儿童多三分之一。随着成本分摊比例上升，各类门诊使用指标均下降：看医生的概率、年度支出、每年就诊次数以及门诊治疗次数。在不同成本分摊水平参保的儿童中，住院支出没有显著差异。预防性保健治疗次数对成本分摊的反应与急性或慢性疾病治疗次数相同。这些结果表明，没有理由不像为急性疾病提供保险那样慷慨地为预防性保健提供保险。
