The Oregon experiment re-examined: the need to bolster primary care

The health policy community in the United States is heatedly discussing the Affordable Care Act of 2010, especially the costs and benefits associated with expanding public health insurance. These debates have been informed by analyses of the randomized expansion of Medicaid insurance in Oregon. Highly publicized findings of this landmark study are being used to predict what might happen in other states that choose to expand Medicaid coverage. However, much of the evidence supporting the benefits of health insurance and access to primary care has been lost in this discourse.

We briefly review the published research findings of the Oregon experiment, highlighting two less publicized studies that support the importance of primary care for robust health systems. We argue that natural policy experiments that reform healthcare financing (for example, recent expansions of public health insurance in the US) must tackle access to, and quality of, primary care if they are to fully evaluate the effect of these changes on population health. Lessons learned from the Oregon experiment are relevant across the globe as national leaders look for ways to bolster their healthcare infrastructure and improve the health of their societies.