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February 26, 1992

Cost-shifting in Oregon

Author Affiliations

National Rehabilitation Hospital Washington, DC

JAMA. 1992;267(8):1072. doi:10.1001/jama.1992.03480080042018

To the Editor.  —I wish to comment on Dr Eddy's thoughtful analysis of Oregon's proposed Medicaid plan that appeared in a recent issue of JAMA.1 The plan proposed by the Oregon Department of Human Resources categorized medical services into 709 services, and proposes payment for the first 588. The number of people covered is expanded under this plan.Eddy discussed several potential criticisms of the Oregon proposal. These criticisms included the question of whether the proposal is, in effect, rationing, and the question of whether the proposal puts an unfair burden on women and children. It seems to me that the proposal will actually not have the effect of dropping coverage for some of the previously covered services, but will merely shift the burden to the physician or health care provider caring for the patients involved.For example, Eddy mentions that treatments for diaper rash, pharyngitis, and superficial