SEATTLE--In the 1970s, Hawaii led the way in state efforts at
controlling health-care costs while expanding coverage; in the
1980s, physicians and insurers in California forged ahead with
managed care; and in the 1990s, Oregon has led the way in prioritizing
health services to provide greater access to care.
Physicians at the American Society of Hematology meeting heard
from a panel of experts involved in the Oregon initiative at a
forum on hematology practice.
Bill Gregory, who headed the commission that devised the priority
system for the Oregon plan, said that the key to success was the
openness of the process of developing the prioritized list.
Earlier, in 1987, he said, legislation that defunded some Medicaid
options, including transplants, was passed without a full airing
before the public. When the state refused to pay for a transplant
for a child dying with leukemia, the public outcry forced a reconsideration
of the way the state provided health care.
To avoid such public relations fiascoes, Mr. Gregory's commisson
strove to get a wide range of input through public hearings, meetings,
and telephone surveys, as well as from physicians working in more
than 50 different specialties and subspecialties.
The diversity of the commission, which included physicians, social
workers, a public health nurse, and consumers, also ensured that
the list would be a true consensus. "There was no individual
agenda on the part of the commission, and we weren't subjected
to lobbying by outside forces," he said.
When appointed to chair the commission, Mr. Gregory, a CPA, foresaw
a rapid process, using computerized data--until he realized that
the necessary data on the cost-effectiveness of medical treatments
did not, for the most part, exist.