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May 1, 1991

Oregon's Bold Medicaid Initiative

Author Affiliations

From Health Economics Research Inc, Waltham, Mass.

From Health Economics Research Inc, Waltham, Mass.

JAMA. 1991;265(17):2237-2238. doi:10.1001/jama.1991.03460170091041

Oregon's plan to prioritize health care services for coverage under its Medicaid program offers a unique opportunity to focus national debate on health insurance reform. There is little question that our present system is a patchwork with many serious failings: (1) continued escalation of costs despite managed care initiatives, utilization management, and prospective payment for hospital care; (2) inequities in physician reimbursement; (3) the large number (>37 million) of Americans who have no insurance and the many more who are underinsured; and (4) the dramatic geographic variations in the use of health services, without corresponding evidence of differences in health. The Oregon plan is a bold attempt to maximize health care benefits for Medicaid recipients within severe budgetary limitations. This ambitious experiment should be encouraged. The value of lessons to be learned— positive and negative—far outweighs the potential risks.

The essence of this plan, as ably described by Hadorn1