Intended for healthcare professionals


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

BMJ 2014; 349 doi: (Published 20 October 2014) Cite this as: BMJ 2014;349:g5976
  1. John Heintzman, assistant professor1,
  2. Rachel Gold, investigator2,
  3. Steffani R Bailey, assistant research professor1,
  4. Jennifer E DeVoe, chief research officer3
  1. 1Oregon Health and Science University, Department of Family Medicine, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA
  2. 2Kaiser Center for Health Research, Portland, Oregon, USA
  3. 3OCHIN, Portland, Oregon, USA
  1. Correspondence to: J Heintzman heintzma{at}
  • Accepted 22 September 2014

John Heintzman and colleagues use less publicized evidence from Oregon to argue that unless access to primary care is improved, the benefits of widening the eligibility for public health insurance on individual and population health will be limited

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.

US public insurance programs

Medicaid and Medicare, the two major public insurance programs in the US, were created in 1965.1 Medicare is available to all citizens and permanent residents aged 65 and older and to younger people who have disabilities or are in need of certain medical procedures (for example, kidney dialysis). Once obtained Medicare membership can be maintained continuously and is federally administered and funded through a general payroll tax.

Medicaid, on the other …

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