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David Piepgrass's avatar

I don't follow you. Up to 10% lower risk of dying can be explained by a 0.8 mmHg difference in blood pressure? How's that? Where does it say that the improved vision is explained by improved glasses? And just what is wrong with using the most recent available research for the "risk of dying index"? I would have expected you to use much more careful reasoning than this!

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Overcoming Bias Commenter's avatar

The Rand HIE study did NOT compare patients who got care free with patients who had to pay for the actual cost of their care; it investigated ONLY the effects of co-pays at the time of service. ALL the groups had excellent insurance. The MAXIMUM out-of-pocket annual cost was only $1000.

The study concluded that co-pays reduced "inappropriate or unnecessary" medical care, but also reduced "appropriate or needed" medical care.

As a doctor this seems obvious to me. Regardless of what they pay (full cash to completely free) patients come in if 1) they think they need help and 2) they think they can afford to be seen. Generally they have no way of knowing whether care is really needed. I have been in practice 30 years and have known a number of patients who though they needed help, couldn't afford it, and died.

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