Astral Codex Ten

Karnataka

4 min read

Karnataka

Article

Karnataka is a recurring place in the Astral Codex Ten archive, appearing 2 times across 2 issues between April 24, 2024 and April 30, 2024. The archive places it in contexts such as “In some parts of the Karnataka study, we lose statistical significance at step 1”; “in the Karnataka study”; “Karnataka was poor Indians who didn’t know how to use insurance”. It most often appears alongside Oregon experiment, RAND Health Insurance Experiment, Robin.

Metadata

  • Category: Places
  • Mention count: 2
  • Issue count: 2
  • First seen: April 24, 2024
  • Last seen: April 30, 2024

Appears In

Source Context

Recovered passages from the original issue text. When the raw archive preserved outbound links inside the source passage, they are listed directly under the quote.

Contra Hanson On Medical Effectiveness
April 24, 2024 · Original source
His argument: there have been three big experimental studies of what happens when people get free (or cut-price) health care: RAND, Oregon, and Karnataka. All three (according to him) find that people use more medicine, but don’t get any healthier. Therefore, medicine doesn’t work. If it looks like medicine works, it’s a combination of anecdotal reasoning, biased studies, and giving medicine credit for the positive effects of other good things (better nutrition, sanitation, etc).
The study had too low power to figure out if hypertension meds worked, and basically could not rule out any level of effectiveness, even effectiveness so high that the meds would instantly kill you by lowering your blood pressure to 0. I don’t think we can summarize this study as “we’ve proven medication doesn’t work”. V. Karnataka Health Insurance Experiment Same story, different scenery. This one happened in India. 10,000 families. End result is: Having measured (a) 3 parameters (direct/indirect/total) for (b) 3 ITT and one TOT effect for (c) 82 specified outcomes over 2 surveys, only 3 (0.46% of all estimated coefficients concerning health outcomes) were significant after multiple-testing adjustments. (As Table A8 shows, 55 parameters (8.38%) are significant if we do not adjust for multiple-testing.) We cannot reject the hypothesis that the distribution of p-values from these estimates is consistent with no differences (P=0.31). We also find no effect of access on our summary index of health outcomes (Table A6 and Table A7). In other words: They tested a lot of stuff
Inline links: This one
In some parts of the Karnataka study, we lose statistical significance at step 1. The better insurance didn’t necessarily result in more medical utilization. For example, it didn’t cause people to be (significantly) more likely to give birth in a hospital or get surgery.
Response to Hanson On Health Care
April 30, 2024 · Original source
The Karnataka experiment couldn’t show that insurance made people more likely to give birth in hospitals, or more likely to have a doctor tell them that their blood pressure was too high, or basically any outcome related to how much care they were getting, let alone whether that care worked.
Scott calls Karnataka a “study where the intervention didn’t affect the amount of medical care people got very much” as “they were unable to find a direct effect of giving people free insurance on those people using insurance, at all, in the 3.5 year study period!” But I see the study as reporting big utilization effects: