The group set out to answer this question (among others): "Does free medical care lead to better health than insurance plans that require the patient to shoulder part of the cost?
[5] Subsequent RAND HIE publications "rule[d] out all but a minimal influence, favorable or adverse, of free care for the average participant"[6] but determined that a "low income initially sick group assigned to the HMO .
[2][8] Studies of specific conditions and diseases in the RAND HIE data found, for example, that the decrease in use of medical services had adverse effects on visual acuity[9] and on blood pressure control.
[citation needed] The RAND HIE is still referenced in the academic literature as a "gold standard" study in research on the effects of health insurance.
[18] They concluded: Increased cost sharing is associated with lower rates of drug treatment, worse adherence among existing users, and more frequent discontinuation of therapy.
For some chronic conditions, higher cost sharing is associated with increased use of medical services, at least for patients with congestive heart failure, lipid disorders, diabetes, and schizophrenia.
[18] Furthermore, the RAND HIE is mentioned regularly in the newsmedia: In 2008, for reasons of cost, Oregon's Medicaid agency accepted 10,000 uninsured low-income adults into its insurance program based on a lottery with 89,824 applicants.