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While the homogeneity of insurance resources available to Vermont populations preclude analysis of the effects of varying co-insurance factors, we have seen the co-insurance and deductible provisions of the Medicare Part B program are ineffective in rationalizing strategies for allocation of health care, supporting a nearly three-fold variation in program The major factor in the expenditure differential between Vermont communities is varying use of related factors do not appear to play an important THE JOURNAL OF THE MAINE MEDICAL ASSOC IATION of self-insurance, it is unclear how a patient-directed co-insurance strategy would reduce these variations or lead to better decisions affecting health farmacia outcome. The technique was that suggested by Miss Ginsberg of the Bingham Associates and onde had been used previously at the Knox County General Hospital.