Does free care improve adults' health? Results from a randomized controlled trial

N Engl J Med. 1983 Dec 8;309(23):1426-34. doi: 10.1056/NEJM198312083092305.


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.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Clinical Trials as Topic
  • Deductibles and Coinsurance / economics
  • Health Services / statistics & numerical data
  • Health Services Research
  • Health Status*
  • Health*
  • Hospitalization
  • Humans
  • Hypertension / therapy
  • Income
  • Insurance, Health / economics*
  • Middle Aged
  • Mortality
  • Random Allocation
  • Statistics as Topic
  • United States
  • Vision Disorders / therapy