Virtually every economist I&#x27;ve ever seen write on this subject over the past several decades has pointed to the same features (required expertise to evaluate quality of services offered against cost, lack of pricing transparency, major needs being unpredictable, lack of the luxury of time to do price shopping -- even if it was possible -- when a need arises, etc.) that has been pointed out in this thread as reasons <i>why</i> health care did correspond to the assumptions of the rational choice model on which the conclusion of the efficiency of free markets with direct user purchasing rests.<p>So, I&#x27;m not surprised by the results of the study, only with the fact that there are &quot;health economists&quot; that find it surprising.