How Free Care Reduced Hypertension of Participants in the RAND Health Insurance Experiment

by Emmett B. Keeler, Robert H. Brook, George A. Goldberg, Caren Kamberg, Joseph P. Newhouse

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In a controlled trial of the effects of medical insurance on spending and health status, the authors previously reported lower average diastolic blood pressure levels (0.8 mm Hg) with free care than with cost-sharing plans. In this report they show that for clinically defined hypertensives, blood pressure levels with free care were significantly lower (1.9 mm Hg) with larger differences for low-income hypertensives than for high-income ones (3.5 compared with 1.1 mm Hg), but with similar differences between blacks and whites. The cause of the difference was the additional contact with physicians under the free-care plan; this led to better detection and treatment of hypertensives not under care at the start of the study. Free care also led to higher compliance by hypertensives with diet and smoking recommendations, and higher use of medication by those who needed it.

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