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Emmett B. Keeler, PhD; Robert H. Brook, MD, ScD; George A. Goldberg, MD; Caren J. Kamberg, MSPH; Joseph P. Newhouse, PhD

JAMA. 1985;254(14):1926-1931.

Abstract
In a controlled trial of the effects of medical insurance on spending and health status, we previously reported lower average (0.8 mm Hg) diastolic blood pressures with free care than with cost-sharing plans. We show herein that for clinically defined hypertensives, blood pressures with free care were significantly lower (1.9 mm Hg) than with cost-sharing plans, with a larger difference for low-income hypertensives than for high-income hypertensives (3.5 vs 1.1 mm Hg), but similar differences for blacks and whites. The cause of the difference was the additional contact with physicians under free care; 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.

(JAMA 1985;254:1926-1931)

Author Affiliations
From the Health Sciences Program, The Rand Corp, Santa Monica, Calif (Drs Keeler, Brook, Goldberg, and Newhouse and Ms Kamberg); and the Departments of Medicine and Public Health (Dr Brook), UCLA Center for the Health Sciences.

Footnotes
The opinions and conclusions expressed herein are solely those of the authors and should not be construed as representing the opinions or policy of The Rand Corp or any agency of the US government.

Reprint requests to the Health Sciences Program, The Rand Corp, 1700 Main St, Santa Monica, CA 90406-2138 (Dr Keeler).

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