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PubMed1991

Prioritization of health care services. A progress report by the Oregon Health Services Commission.

The Oregon Health Services Commission is composed of a group of 11 consumers and health care professionals. It was appointed by the governor as required by the "Oregon Basic Health Services Act" to produce a prioritized list of health services ranked on the basis of their relative importance to populations served. Following actuarial analysis, the legislature will determine the extent to which the "list" of services can be funded to provide health care access for Medicaid recipients earning up to the 100th percentile of the federal poverty level. Prioritization will be based on a cost-benefit formula applied to each treatment/condition unit and assignment of each of these to a general category, which itself has been ranked on the basis of "public value."

Advisory Committees↗

PubMedDate not supplied

Setting health care priorities: Oregon's next steps.

Since the proposal was first broached in 1987, a storm of controversy has engulfed Oregon's plan to prioritize the health care services offered to its Medicaid recipients. After two years of debate, community consultation, and public opinion polls, the Oregon Health Services Commission was mandated in 1989 to study prioritization as part of a package of bills enacted as the Oregon Basic Health Services Act. In March 1990 the commission released a draft list of ranked health care services for public comment... As part of the ongoing debate, the Hastings Center and the Wesley Foundation sponsored a two-day meeting in January 1991 in Wichita, Kansas, to provide opportunity for thoughtful, in-depth, informal analysis of the OBHSA model for health care reform...a majority felt that OBHSA, in the framework of progress toward larger reform goals, is an experiment worth trying. Some felt that even if OBHSA doesn't attain its larger goals it should be tried since it will extend access and may lead to better health outcomes among the poor. But the general view was that OBHSA is a valuable experiment only to the extent that it leads to a statewide system of universal health insurance in Oregon without creating special burdens for the state's poor....

Biomedical Technology↗

PubMed1991

Priority setting: lessons from Oregon.

The state of Oregon has developed a unique method to set priorities for health services. The method is based on a cost-utility formula but also incorporates public attitudes and values. Using an explicit process, the Oregon Health Services Commission has completed the ranking of 714 condition-treatment pairs. The background, methods, and criticisms of the Oregon approach highlight key questions for managers and physicians in other health services when they allocate limited resources.

Community Participation↗

PubMed1991

Setting health care priorities in Oregon. Cost-effectiveness meets the rule of rescue.

The Oregon Health Services Commission recently completed work on its principal charge: creation of a prioritized list of health care services, ranging from the most important to the least important. Oregon's draft priority list was criticized because it seemed to favor minor treatments over lifesaving ones. This reaction reflects a fundamental and irreconcilable conflict between cost-effectiveness analysis and the powerful human proclivity to rescue endangered life: the "Rule of Rescue." Oregon's final priority list was generated without reference to costs and is, therefore, more intuitively sensible than the initial list. However, the utility of the final list is limited by its lack of specificity with regard to conditions and treatments. An alternative approach for setting health care priorities would circumvent the Rule of Rescue by carefully defining necessary indications for treatment. Such an approach might be applied to Oregon's final list in order to achieve better specificity.

Cost-Benefit Analysis↗

PubMed1998

Linking measures of health gain to explicit priority setting by an area health service in Australia.

A demonstration project was undertaken to develop an integer programming model that could help a regional health authority to take into account data on service effectiveness when allocating resources to acute inpatient services. The model was designed to find the mix of services that would maximise health gain from the available resources, and so provide information that could be used to encourage hospitals to change their patient mix. It was developed in collaboration with an Area Health Service in New South Wales, Australia, with the aim of assessing its potential as a decision support tool. Acute inpatient services were categorised in the model using classes derived from the Australian National Diagnosis Related Groups (AN-DRG) classification and the classes developed by the Oregon Health Services Commission. Estimates for the effectiveness of each service was derived from the Oregon benefit data. Estimates of resource use were derived from AN-DRG data. The expected demand for each service was derived from local activity data. Various scenarios were developed to assess the potential of the model to support decision makers. These mimicked plausible policy options and tested the sensitivity of the results to changes in the data. The scenarios demonstrated the model could reveal the consequences of different policy options, but also suggested that the difference in the cost-effectiveness of services close to the margin would be small and so a rigid approach to priority setting is undesirable. Difficulties in developing the model also demonstrate that incorporating health gain data into resource allocation decisions will not be straight-forward for health planners.

Cost-Benefit Analysis↗

PubMed1993

Unjustified use of the Quality of Well-Being Scale in priority setting in Oregon.

The Quality of Well-Being Scale (QWB) is an instrument for valuing health states on a continuum from unity (healthy) to zero (dead). While it seems safe to assume that the values have ordinal properties, there is neither theoretical nor empirical basis for claiming that they have the cardinal properties that are required in calculations of social benefit in cost-utility analysis. Failure to recognize this led the Oregon Health Services Commission to produce a QWB-based priority list with a number of counterintuitive rankings. A set of health state values based on upper end compression would have produced a list more in accordance with public preferences.

Algorithms↗

PubMed2002

Interpreting public input into priority-setting: the role of mediating institutions.

Discussions about public participation in health priority-setting have tended to assume that the best type of information about public values is that in which the public 'speaks for itself'. However, wherever public input has been used in priority-setting, the way in which it is used is far from transparent. Those jurisdictions that have initiated priority-setting processes have been characterised by the substantial involvement of 'mediating bodies' i.e. bodies such as the Oregon Health Services Commission or the New Zealand National Health Committee, that take on the role of interpreting information about public values. The information that they interpret is usually presented in a highly ambiguous form and most definitely does not 'speak for itself'. In the priority-setting literature, however, little attention has been paid to the role of these bodies and the way in which they interpret and digest information about public values. This article argues that these bodies are essential, but that their decision-making processes are necessarily opaque and should not be judged according to the criterion of transparency.

Community Participation↗

PubMedDate not supplied

The Oregon priority-setting exercise: quality of life and public policy.

In 1989 the Oregon State legislature passed the Oregon Basic Health Services Act, which created a Health Services Commission charged with "developing a priority list of health services, ranging from the most important to the least important for the entire population to be served." The goal of this legislation was to permit the expansion of Medicaid to 100 percent of all Oregonians living in poverty by covering only services deemed to be of sufficient importance or priority...Instead, the OHSC developed a set of seventeen health service "categories," which described either a specific type of service...or, more generically, the expected outcomes of care... Commissioners formally ranked these seventeen categories in order of importance according to three subjective criteria: value to the individual, value to society, and whether the category seemed "necessary." Each treatment was then assigned to the single most appropriate category, based on Commissioners' judgment. Services were ranked within categories according to the degree of benefit expected from treatment... Estimates of how treatments affect quality of life were by far the single most important factor in determining the priority order on that list....

Biomedical Technology↗

PubMed1991