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CMAJ • May 29, 2001; 164 (11)
© 2001 Canadian Medical Association or its licensors

Review
Synthèse

Rationing medical care: rhetoric and reality in the Oregon Health Plan

Jonathan Oberlander*, Theodore Marmor{dagger} and Lawrence Jacobs{ddagger}

From the *School of Medicine, University of North Carolina–Chapel Hill, Chapel Hill, NC; the {dagger}School of Management, Yale University, New Haven, Conn.; and the {ddagger}Department of Political Science, University of Minnesota, Twin Cities campus, Minneapolis–St. Paul, Minn.

Abstract

The Oregon Health Plan (OHP) has been widely heralded as an important innovation in medical care policy and rationing. Oregon's pioneering method of prioritizing funding for health care through systematic and public ranking of medical services has drawn substantial international interest. This paper reviews the experience of the Oregon plan since it began operation in 1994. We argue that widespread misconceptions persist about the significance of the OHP. In particular, there is little evidence that the OHP has operated as a model of explicit rationing. In reality, Oregon has not rationed services, nor has its policy of cutting public coverage for services produced substantial savings. These findings have important implications regarding the desirability and feasibility of adopting a policy of removing items from the list of insured medicare services in Canada. Oregon's experience suggests that drawing the line on medicare coverage would be more difficult and less financially rewarding than advocates claim.




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