Rationing Revisited

In 1993, the Department of Health and Human Services granted Oregon a Medicaid waiver that allowed Oregon to implement a health plan prioritizing payment for certain types of treatments. The federal government granted this waiver at about the same time the managed care revolution transformed the provision of healthcare in the United States. The health plan, implemented in 1994, has expanded healthcare coverage for uninsured individuals in Oregon.In recent years, healthcare spending has increased at an astronomical rate, and more and more Americans have become unable to afford health insurance. In an effort to curtail this disturbing trend, managed care plans have implemented certain cost containment measures, such as re-quiring approval by a primary care provider or preauthorization from the plan’s administrator before the insured can undergo certain procedures. Many Americans have reacted negatively to managed care because it limits their choices—otherwise known as rationing their healthcare. In this article, Dr. Rice examines the Oregon Health Plan and asks whether that plan represents the rationing of healthcare.

The full text of this Symposium is available to download as a PDF.