Excellus Health Plan, Inc.

Oregon's Initiative Promises Wealth of Experience to Guide Health Care ReformAuthor(s): Bernard R. TresnowskiSource: Inquiry, Vol. 28, No. 3 (Fall 1991), pp. 207-208Published by: Excellus Health Plan, Inc.Stable URL: http://www.jstor.org/stable/29772216 .

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Oregon's Initiative Promises Wealth of Experience to Guide Health Care Reform

Inquiry readers probably have grown accustomed to my practical approach to health

care research. In past editorials I have called attention to articles focusing on a broad

range of issues, always looking for lessons to guide health care policy, highlighting

questions that merit more study and analysis. I have a high regard for research,

especially when it offers answers to pressing questions and supports productive action.

Sometimes, however, research seems to be an end in itself, an endless quest for more and better information. It is never easy to know when we have enough data to support a decision. There are always opportunities for "further study."

But at some point we must act on the information at hand, balancing uncertainty with caution and common sense.

Perhaps this was the Oregon legislature's belief when it enacted its controversial

program to finance Medicaid eligibility expansions with savings generated by reducing the scope of covered services. In the months following that decision, skeptics have

had a field day, criticizing the empirical foundation for defining priority care, challeng?

ing the basis on which value is assigned to services, and questioning the legisla? ture's political and social agenda.

Many of their concerns may be well founded.

Rationing care for one subgroup of the population-a group especially vulnerable due to their inability to supplement publicly funded care?certainly raises moral and ethical issues. Consensus-based decision making is a difficult process, which can give greater weight to the loudest and most persuasive voices.

Nevertheless, the Oregon Health Services Act represents a bold action that pushes ahead on largely uncharted territory, and promises a wealth of experience to guide other states and the federal government in their decisions on health care system reform.

Thomas Grannemann's article in this issue of Inquiry, "Priority Setting: A Sen? sible Approach to Medicaid Policy?," offers an insightful analysis of Oregon's initia? tive. Grannemann reviews Oregon's methodology for identifying priority services and suggests that the program offers a fair method for establishing total program expenditures, but a less reasonable method for specifying covered services.

Grannemann suggests that by assigning resource allocation decisions to

physicians?through extensive use of capitated delivery systems-Oregon can min? imize some of the risk inherent in its experiment.

In the coming months, more states are likely to design their reform initiatives

Inquiry 28: 207-208 (Fall 1991). ? 1991 Blue Cross and Blue Shield Association.

0046-9580/91/2803-0207$1.25 207

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Inquiry/Volume 28, Fall 1991

through a process of political consensus influenced by fiscal restraint and based on a limited knowledge base. These three factors, political consensus, fiscal re?

straint, and limited information may dominate health policy decision making in

the near future. Clearly, they will be influential forces in national health care re?

form as well.

The pressure for health system reform will not abate while we pursue better and more directive information. We will need to proceed with what we have, acting

cautiously to do no harm in our enthusiasm to do good. In the absence of more complete knowledge regarding service effectiveness and

treatment outcomes, and without measures that balance the need for acute care ser?

vices with the growing demand for chronic care, the final arbiter of access will

continue to be the health care practitioner. Efforts to manage cost and assure access

will need to support these professionals in this critical role.

Bernard R. Tresnowski, President

Blue Cross and Blue Shield Association

208

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