Ore. plan to ration care assailed

February 25, 1992|By New York Times News Service

WASHINGTON -- A congressional research agency has criticized Oregon's novel effort to ration health care by ranking all services according to their costs and benefits.

The agency, the Congressional Office of Technology Assessment, said in a confidential draft of a report to be issued this spring that the rankings were largely subjective and would deprive some low-income people of Medicaid services to which they are now entitled.

Overall, the OTA, which advises Congress on scientific questions, said it had "serious reservations" about Oregon's project.

Oregon's effort to restrain health costs and improve access to care has attracted more interest and generated more debate than any other state's efforts. It has been cited by Bush administration officials as an example of the state experimentation that they wish to encourage.

Sen. Al Gore Jr., a Democrat from Tennessee, has described the debate over Oregon's plan as "the single most important debate on the future of health care in the United States."

Oregon's rationing plan is "superficially attractive to many state legislatures," confronted with soaring health costs and millions of people needing insurance, he said.

Oregon would expand Medicaid to cover all state residents below the poverty level, which was $10,857 for a family of three last year. But it would reduce the level of services, refusing to pay for medical treatments that rank below No. 587 on a list of 709 medical procedures.

The OTA said the technique used by Oregon to set priorities for health services was "not an especially promising approach." In ranking various treatments, Oregon considered their cost in relation to their effectiveness. It also weighed their contribution, if any, to a patient's quality of life and to the well-being of society.

Under current law, children under the age of 21 are entitled to all medically necessary services if they are enrolled in Medicaid. Under the Oregon plan, there is no minimum set of benefits.

The OTA said the lack of a guaranteed set of benefits was "the most disturbing aspect of Oregon's proposal."

For instance, the report said that under Oregon's plan the state Medicaid program would no longer have to pay for the treatment of viral pneumonia, viral hepatitis, chronic bronchitis, certain types of asthma or certain back sprains because the treatments rank below line 587 on the list of qualifying medical procedures.

Nor would it have to pay for treating cancer when doctors concluded that a patient had less than a 10 percent chance of surviving for five years or more.

Oregon's Medicaid director, Jean I. Thorne, defended the state's program and said the OTA's criticism was based on speculation about the worst possible consequences.

She said the list of 709 services looked subjective because it "incorporates value judgments" of Oregonians.

The OTA was created in 1972. It operates under a bipartisan board composed of six senators, six House members and an office director.

The OTA, widely praised as technically proficient and politically neutral, has issued reports on such topics as nuclear weapons, cancer rates, toxic wastes, lie detectors and government computers.

Oregon wants to begin its new health program in July, but it needs permission from the federal Department of Health and Human Services to disregard certain requirements of the federal Medicaid law.

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