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April 1, 1992

Cost Containment in Oregon: As Simple as A×B?

JAMA. 1992;267(13):1780. doi:10.1001/jama.1992.03480130092028

To the Editor.  —In his review of Oregon's methods for cost containment, Dr Eddy1 argues with his usual clarity that the failure was due to errors in the data (specifically cost data errors and imprecision in Quality of Well-Being Scale state definitions), the omission of important value elements (eg, the Rule of Rescue or the vicarious utility), and the misapplication of one particular method, directed toward "egalitarian" goals, when another priority setting should have been adopted. His argument does not allow for inherent failures or shortcomings of cost analysis per se.But in his defense he should have, while in the process of allowing for multiple-weighting factors and cost or benefit scales, at least asked the question whether the numerical expressions of the different scales and weighting values form numbering systems that are isomorphic to each other. If they are not, accurate estimates of all the value systems