PEDIATRICS Vol. 75 No. 5 May 1985, pp. 952-961
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Consequences of Cost-Sharing for Children's Health

R. Burciaga Valdez MNSA1, Robert H. Brook MD, ScD1, William H. Rogers PhD1, John E. Ware Jr PhD1, Emmett B. Keeler PhD1, Cathy A. Sherbourne MA1, Kathleen N. Lohr PhD1, George A. Goldberg MD1, Patricia Camp MS1, and Joseph P. Newhouse PhD1

1 From the Departments of Economics, Behavioral Sciences, and System Sciences, The Rand Corporation, Santa Monica, California, and Washington, DC, and Departments of Medicine and Public Health, Center for the Health Sciences, University of California at Los Angeles, Los Angeles

Do children whose families bear a percentage of their health care costs reduce their use of ambulatory care compared with those families who receive free care? If so, does the reduction affect their health? To answer these questions, 1,844 children aged 0 to 13 years were randomly assigned (for a period of 3 or 5 years) to one of 14 insurance plans. The plans differed in the percentage of their medical bills that families paid. One plan provided free care. The others required up to 95% coinsurance subject to a $1,000 maximum. Children whose families paid a percentage of costs reduced use by up to one third. For the typical child in the study, this reduction caused no significant difference in either parental perceptions of their child's health or in physiologic measures of health. Confidence intervals are sufficiently narrow for most measures to rule out the possibility that large true differences went undetected. Nor were statistically significant differences observed for children at risk of disease. Wider confidence intervals for these comparisons, however, mean that clinically meaningful differences, if present, could have been undetected in certain subgroups.

Key Words: health status • health care financing • insurance plans • cost-sharing

Submitted on May 10, 1984
Accepted on January 7, 1985




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