The Oregon experience in the provision of universal health care, CHERE Discussion Paper No 4

The Oregon Experiment is an attempt to provide universal access to health care while achieving budgetary caps on expenditure. The appeal of the experiment lies in its explicit approach to rationing health care within a framework of cost effectiveness analysis and its involvement of the community in priority setting. The purpose of this paper is to review the history, process and progress of the Oregon Plan in the context of resource allocation in health care generally and the specific problems of US health care. The relevance of the Oregon approach to Australia is considered. The problems of resource allocation in health care are not new, nor are they confined to Oregon. Section 1 of the paper discusses the general problems as these must be understood before considering the Oregon "solution". The particular problem in Oregon, as in the rest of the US, is the rising number of people not covered by health insurance and not eligible for government benefits. The essence of the Oregon approach is to provide universal access to health care but to limit the particular conditions and treatments which could be provided. Section 2 covers the history and development of this approach. The problems and criticisms of the Oregon approach are discussed in section 4. The implementation of the Plan does not live up to the rhetoric; in reality the implementation has been limited by the lack of data on both costs and benefits of health care interventions and the restricted extent of community consultation and involvement. Could or should the Oregon Experiment be tried in Australia? It is important to realise that the Oregon Plan provided access to health care to a significant group, but nonetheless a minority of Oregon citizens; the use of health care services by the majority of the Oregon population is not rationed by the Plan. The Oregon approach, therefore, is a response to the particular problems of Oregon, not Australia. The lesson that Australia could learn from Oregon is that the development of open and informed debate and the rationing of health care resources requires community involvement in the debate fostered through surveys of community values.