ABSTRACT
In 1994 Oregon began rationing health care for its Medicaid population, offering health policy makers and analysts around the country a view of one alternative future for health care delivery. The question now, four years after the experiment began, is what does that future look like? The short answer is that it does not look all that different from the present, but it looks different enough to offer important lessons to other states and the federal government. The Oregon experiment, including the prioritization of services and the aggressive use of managed care, has facilitated the expansion of health care coverage to over 100,000 additional Oregonians, helped decrease the percentage of the uninsured as well as reduce uncompensated care in hospitals, reduced the use of hospital emergency rooms, and reduced cost shifting. By most measures, the Oregon experiment appears to be a success.
Subject(s)
Health Care Rationing/organization & administration , Managed Care Programs/organization & administration , Medicaid/organization & administration , Resource Allocation , State Health Plans/organization & administration , Cost Allocation , Forecasting , Health Priorities/organization & administration , Humans , Medically Uninsured/statistics & numerical data , Oregon , Politics , United States , Withholding TreatmentSubject(s)
Attitude to Health , Managed Care Programs/organization & administration , Medicaid/organization & administration , Poverty , Regional Health Planning/organization & administration , Child , Child, Preschool , Consumer Behavior , Disabled Persons , Female , Health Services Accessibility , Health Status , Humans , Infant , Infant, Newborn , Oregon , Organizational Innovation , Pregnancy , Program Evaluation , United StatesABSTRACT
It seemed inconceivable that Vermont would not enact comprehensive health care reform in 1994. Two years earlier the Vermont legislature had created the Vermont Health Care Authority to prepare the groundwork for major reform. Yet the 1994 Vermont General Assembly could not reach agreement on legislation. What went wrong? Some on the political left and right say that the legislature stopped "bad" legislation. The Vermont story reveals the failure of reformers to convince interest groups and ordinary citizens about the capacity of government to reform the health system.
