Lecture4 - Lecture 4 The Road To Health Care Reform 15:10...

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Lecture 4: The Road To Health Care Reform 15:10 The Oregon Plan 1980’s (late) – Oregon’s legislature stopped payments for organ transplants  for Medicaid patients belief of prenatal care for women should have more priority than organ  transplants Cost Factors 1989 – “Oregon health plan”  o access to health care for nearly all Oregonians Bill had 3 parts o Medicaid expansion – cover more people o Health services commission to prioritize list for basic benefits package for  Medicaid o Require employers to provide benefits Goal  o Originally targeted Medicaid first o Expanded reform to include employer mandates later o By limiting the number of services covered, they could extend coverage to  those who had no coverage before o KEY POINT – RATIONING CARE, NOT PEOPLE Values discussed at the meetings o Top ones included Prevention Quality of life Equity
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Cost-effectiveness Community compassion Use of Framing  o Ration services, not people Change the debate on WHAT is covered not WHO is covered Reduce the services that Medicaid patients get, not reduce the number  of people getting services. o Equity and Justice in accessing health care o Focused on reducing unnecessary or “marginally beneficial” services Early Critics o Disability groups felt their member services were not fully covered o Said that it will target “the seriously ill” Deliberation o Prioritized list of health services with some not covered at all o Top of list was acute problems that might be fatal and where surgery or  treatments could lead to recovery “appendicitis” o Also at the top were preventive services such as maternity care and 
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Lecture4 - Lecture 4 The Road To Health Care Reform 15:10...

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