Published 14 October 2008, doi:10.1136/bmj.a2044
Cite this as: BMJ 2008;337:a2044

Feature

Rationing

Why Oregon went wrong

¹ Department of Health and Human Services, Washington DC, USA

Analysis doi:10.1136/bmj.a1850, doi:10.1136/bmj.a1872, doi:10.1136/bmj.a1846

Oregon’s brave plan to explicitly ration health care in order to cover more people soon ran into problems. Vidhya Alakeson looks at the reasons and asks whether history will repeat itself

The first 150 words of the full text of this article appear below.

Oregon attracted international attention after its decision to introduce a system to transparently ration treatments in its Medicaid programme, known as the Oregon Health Plan. But two decades on, the story that has emerged from the Oregon experiment is not the expected one of controversy linked to healthcare rationing. The real story centres on the limitations of this approach in controlling healthcare costs and sustaining state health reform, particularly in tough economic times. As the US electorate expects national health reform next year, the fate of the Oregon Health Plan is a timely warning.

The Oregon Health Plan was created in 1989 to expand coverage to some of the 400 000 citizens who at the time had no health insurance. Spearheaded by state senator turned governor John Kitzhaber, the plan was intended to extend coverage to people with incomes less than 100% of the federal poverty level ($12 100 (£7000; . . . [Full text of this article]

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