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The RAND Health Insurance Experiment, Three Decades Later

Author

Listed:
  • Aviva Aron-Dine

    (NBER)

  • Liran Einav

    (Stanford University)

  • Amy Finkelstein

    (Massachusetts Institute of Technology)

Abstract

We re-present and re-examine the analysis from the famous RAND Health Insurance Experiment from the 1970s on the impact of consumer cost sharing in health insurance on medical spending. We begin by summarizing the experiment and its core findings in a manner that would be standard in the current age. We then examine potential threats to the validity of a causal interpretation of the experimental treatment effects stemming from different study participation and differential reporting of outcomes across treatment arms. Finally, we re-consider the famous RAND estimate that the elasticity of medical spending with respect to its out-of-pocket price is -0.2, emphasizing the challenges associated with summarizing the experimental treatment effects from non-linear health insurance contracts using a single price elasticity.

Suggested Citation

  • Aviva Aron-Dine & Liran Einav & Amy Finkelstein, 2012. "The RAND Health Insurance Experiment, Three Decades Later," Discussion Papers 12-007, Stanford Institute for Economic Policy Research.
  • Handle: RePEc:sip:dpaper:12-007
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    1. Marianne P. Bitler & Jonah B. Gelbach & Hilary W. Hoynes, 2006. "What Mean Impacts Miss: Distributional Effects of Welfare Reform Experiments," American Economic Review, American Economic Association, vol. 96(4), pages 988-1012, September.
    2. Amanda Kowalski, 2016. "Censored Quantile Instrumental Variable Estimates of the Price Elasticity of Expenditure on Medical Care," Journal of Business & Economic Statistics, Taylor & Francis Journals, vol. 34(1), pages 107-117, January.
    3. Steven D. Levitt & John A. List, 2011. "Was There Really a Hawthorne Effect at the Hawthorne Plant? An Analysis of the Original Illumination Experiments," American Economic Journal: Applied Economics, American Economic Association, vol. 3(1), pages 224-238, January.
    4. Manning, Willard G, et al, 1987. "Health Insurance and the Demand for Medical Care: Evidence from a Randomized Experiment," American Economic Review, American Economic Association, vol. 77(3), pages 251-277, June.
    5. Morris, Carl, 1979. "A finite selection model for experimental design of the health insurance study," Journal of Econometrics, Elsevier, vol. 11(1), pages 43-61, September.
    6. Rodrigo Pinto & Azeem Shaikh & Adam Yavitz & James Heckman, 2010. "Inference with Imperfect Randomization: The Case of the Perry Preschool Program," 2010 Meeting Papers 1336, Society for Economic Dynamics.
    7. Kowalski, Amanda E., 2015. "Estimating the tradeoff between risk protection and moral hazard with a nonlinear budget set model of health insurance," International Journal of Industrial Organization, Elsevier, vol. 43(C), pages 122-135.
    8. repec:mpr:mprres:7005 is not listed on IDEAS
    9. Joshua Angrist & Eric Bettinger & Michael Kremer, 2006. "Long-Term Educational Consequences of Secondary School Vouchers: Evidence from Administrative Records in Colombia," American Economic Review, American Economic Association, vol. 96(3), pages 847-862, June.
    10. Aviva Aron-Dine & Liran Einav & Amy Finkelstein & Mark Cullen, 2012. "Moral hazard in health insurance: How important is forward looking behavior?," Discussion Papers 11-007, Stanford Institute for Economic Policy Research.
    11. David S. Lee, 2009. "Training, Wages, and Sample Selection: Estimating Sharp Bounds on Treatment Effects," The Review of Economic Studies, Review of Economic Studies Ltd, vol. 76(3), pages 1071-1102.
    12. Keeler, Emmett B & Newhouse, Joseph P & Phelps, C E, 1977. "Deductibles and the Demand for Medical Care Services: The Theory of a Consumer Facing a Variable Price Schedule under Uncertainty," Econometrica, Econometric Society, vol. 45(3), pages 641-655, April.
    13. Krueger, Alan B & Whitmore, Diane M, 2001. "The Effect of Attending a Small Class in the Early Grades on College-Test Taking and Middle School Test Results: Evidence from Project STAR," Economic Journal, Royal Economic Society, vol. 111(468), pages 1-28, January.
    14. James Heckman & Seong Hyeok Moon & Rodrigo Pinto & Peter Savelyev & Adam Yavitz, 2010. "Analyzing social experiments as implemented: A reexamination of the evidence from the HighScope Perry Preschool Program," Quantitative Economics, Econometric Society, vol. 1(1), pages 1-46, July.
    15. Amy Finkelstein, 2007. "The Aggregate Effects of Health Insurance: Evidence from the Introduction of Medicare," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 122(1), pages 1-37.
    16. Charles Michalopoulos & David Wittenburg & Dina A. R. Israel & Jennifer Schore & Anne Warren & Aparajita Zutshi & Stephen Freedman & Lisa Schwartz, "undated". "The Accelerated Benefits Demonstration and Evaluation Project: Impacts on Health and Employment at Twelve Months," Mathematica Policy Research Reports 00f10b2f7afb4f56b0e79bb01, Mathematica Policy Research.
    17. repec:pri:indrel:dsp01rv042t06t is not listed on IDEAS
    18. Joseph P. Newhouse, 1992. "Medical Care Costs: How Much Welfare Loss?," Journal of Economic Perspectives, American Economic Association, vol. 6(3), pages 3-21, Summer.
    19. Ashenfelter, Orley & Plant, Mark W, 1990. "Nonparametric Estimates of the Labor-Supply Effects of Negative Income Tax Programs," Journal of Labor Economics, University of Chicago Press, vol. 8(1), pages 396-415, January.
    20. Keeler, Emmett B. & Rolph, John E., 1988. "The demand for episodes of treatment in the health insurance experiment," Journal of Health Economics, Elsevier, vol. 7(4), pages 337-367, December.
    21. repec:fth:prinin:259 is not listed on IDEAS
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    JEL classification:

    • I13 - Health, Education, and Welfare - - Health - - - Health Insurance, Public and Private

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