Does Free Care Improve Adults' Health?

TLDR

The study examines whether free medical care leads to better health outcomes than insurance plans that require cost sharing. The authors aimed to determine whether free care improves health by comparing outcomes among adults assigned to free versus cost‑sharing plans. They randomized 3,958 adults aged 14–61 to either a free‑care plan or plans requiring a share of medical bills over three to five years. Free care was associated with one‑third fewer physician visits and hospitalizations, improved vision and lower diastolic blood pressure in low‑income, high‑BP patients, but had no significant effect on eight other health measures for the average participant, with narrow confidence intervals ruling out substantial influence. N Engl J Med 1983; 309:1426–34.

Abstract

Abstract Does free medical care lead to better health than insurance plans that require the patient to shoulder part of the cost? In an effort to answer this question, we studied 3958 people between the ages of 14 and 61 who were free of disability that precluded work and had been randomly assigned to a set of insurance plans for three or five years. One plan provided free care; the others required enrollees to pay a share of their medical bills. As previously reported, patients in the latter group made approximately one-third fewer visits to a physician and were hospitalized about one-third less often. For persons with poor vision and for low-income persons with high blood pressure, free care brought an improvement (vision better by 0.2 Snellen lines, diastolic blood pressure lower by 3 mm Hg); better control of blood pressure reduced the calculated risk of early death among those at high risk. For the average participant, as well as for subgroups differing in income and initial health status, no significant effects were detected on eight other measures of health status and health habits. Confidence intervals for these eight measures were sufficiently narrow to rule out all but a minimal influence, favorable or adverse, of free care for the average participant. For some measures of health in subgroups of the population, however, the broader confidence intervals make this conclusion less certain. (N Engl J Med 1983; 309:1426–34.)