Oregon's bold Medicaid initiative
Article Abstract:
The health care plan proposed in Oregon that assigns priority rankings to services for Medicaid recipients is reviewed. The author considers it a ''bold'' plan that tries to ensure maximal health benefits for the poor within budgetary limitations. Although imperfect, the plan should be supported, in part because much can be learned from it. The plan, outlined in another article in the May 1, 1991 issue of The Journal of the American Medical Association, rank-orders categories of health services (specific treatments), and also rank-orders diagnosis-treatment pairs within each category according to their expected health benefits. The model does not include cost as a consideration, and the Oregon legislature will establish a ''cut point'' for coverage according to the Medicaid budget. The plan can be criticized on three counts: whether the benefit rankings are valid; the neglect of cost considerations; and its overall implications for rationing health care for the poor. The diagnosis-treatment pairs need to be made more specific, since the net benefits within one category vary considerably. It does not appear that scientific evidence has been the basis for the priority-setting efforts as much as subjectivity has been, and documentation of the rationale for the plan will undoubtedly be necessary. The role of cost-effectiveness analysis in the health care plan is evaluated. When resources are limited, choices must be made that govern whether all people should receive basic care, or a few should receive specialized care. Rationing of health care, the author argues, is inevitable unless more money is provided: thus, the only relevant question is whether rationing should be explicit or implicit. The plan is innovative, but should include an appeals process to resolve inequities. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: JAMA, The Journal of the American Medical Association
Subject: Health
ISSN: 0098-7484
Year: 1991
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Is the Oregon rationing plan fair?
Article Abstract:
An evaluation is presented of the consequences of the health care rationing plan for the poor proposed by the Oregon Basic Health Services Act: the act requires access for all Oregonians to basic medical care but rations services to Medicaid recipients. Is it fair? The plan differs from other rationing approaches used in the US in that it excludes services, rather than people, from coverage, and, while allowing basic care for all, establishes a public process to determine the services that should be included in that care. The plan has been criticized for making only the poor (particularly poor women and children) subject to rationing. Three issues important in judging the plan are evaluated: whether it improves, or makes worse, the lot of the poor; whether the inequalities proposed by the plan are justifiable; and whether the way the level of basic care is determined is fair. The overall effects on the poor are impossible to determine until more is known about the Medicaid benefit package that will be offered, and more is known about other aspects of the plan. Providing poor people with services ultimately makes them more equal to other segments of society, so it cannot be said that such a plan widens the gap between the poor and everyone else. But on balance, the plan perpetuates inequality, and does not address fundamental issues such as inefficiency and rising costs. While many aspects are laudable, the Oregon plan should not be expanded to a national health care plan. Two other articles in the May 1, 1991 issue of The Journal of the American Medical Association discuss the Oregon plan. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: JAMA, The Journal of the American Medical Association
Subject: Health
ISSN: 0098-7484
Year: 1991
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HIV-infected professionals, patient rights, and the 'switching dilemma'
Article Abstract:
The Centers for Disease Control (CDC) issued new guidelines in Jul 1991 for health care workers infected with HIV or hepatitis B who perform invasive procedures. The guidelines recommend that infected health care workers not perform exposure-prone procedures, and exposure-prone procedure will be defined on a case-by-case basis. The CDC estimates that the risk of contracting HIV from an infected surgeon during an invasive procedure is between one in 40,000 and one in 400,000. This risk is much smaller than others encountered every day by patients. But if patients know that a surgeon is infected with HIV, they may avoid the risk of infection completely by switching to an uninfected surgeon. Physicians should try to protect their patients from risk, but a surgeon infected with HIV may not be obligated to refrain from surgery. The CDC risk estimate does not specify whether the rights of patients or the rights of HIV-infected surgeons should be given higher priority. Enforcement of the CDC guidelines may be expensive, and they may discriminate against HIV-infected health care workers.
Publication Name: JAMA, The Journal of the American Medical Association
Subject: Health
ISSN: 0098-7484
Year: 1992
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