From: Robin Hanson (rhanson@gmu.edu)
Date: Tue Feb 08 2000 - 11:26:12 MST
Robert Bradbury wrote:
> > > > On the effect of medicine overall in the US, I point you to:
> > > > Joseph P. Newhouse And The Insurance Experiment Group,
> > > > Free For All? Lessons from the RAND Health Insurance Experiment,
> > > > Harvard University Press, 1993, ISBN 0-674-31914-1
> >
> > The book I cited is a summary of a 50M$ controlled experiment of 5000
> > people over 3-5 years where some where randomly given free health care
> > and others were instead given a small subsidy.
>
>Robin, was this a government funded "experiment"?
Yes.
> > Those given free care incured ~30% more expenses, and yet had almost
> > identical health.
>
>Hmmmm, by that argument then, England should have a higher health
>care bill per capita than the U.S., yes?
No. By "free" I meant as in paying for as much fee for service care
as desired. England is more like an HMO model, where its free but
you can't have as much as you want. The experiment also included
an HMO type alternative, which also gave the same health outcomes.
> From the description you give, I would say this is a poor source to
>use in debates regarding vaccines for the following reasons.
I didn't mean it to be regarding vaccines specifically. I said it
was regarding medicine overall. It shows the health consequences of
cutting back on 30% of health care spending. If vaccines aren't part
of that cutback, the experiment doesn't talk about them.
>vaccines you have to look at the "costs" of those deaths and the
>degree to which they are prevented by vaccinations ...
Yes, of course. The hard part is finding data you can believe about
effectiveness.
>If you are going to look at Medical costs, I think you have to look
>at treatments on a case-by-case basis to determine whether or not
>those treatments should be used.
Of course that is the ideal. Unfortunately, the vast majority of
medical procedures do not have support from randomized clinical trials.
(Many of them in fact have mostly randomized trials against them.)
And even given supporting randomized trials, you have to wonder how
standard practice on typical patients differs from the best practice
on most-likely-to-benefit patients found in the published trials.
Given this, looking at overall effectiveness of medicine is informative.
Robin Hanson rhanson@gmu.edu http://hanson.gmu.edu
Asst. Prof. Economics, George Mason University
MSN 1D3, Carow Hall, Fairfax VA 22030
703-993-2326 FAX: 703-993-2323
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