Social-Insurance-based Health System

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The usual criteria for determining priorities for action include the number of people affected in the age group of 19-64; the extent of individual suffering; the interventions available to improve quality of life of those affected; the cost per case of the intervention; and the total cost of helping everyone affected by the problem.


A much-cited example of rational priorities for medical care comes from the state of Oregon, where a commission was appointed in 1989 to make recommendations to the state legislature on how to expand coverage and set priorities in the Medicaid program. Underinsured people were to be added to the Medicaid list to cover every resident whose income was below a certain level, but this could be afforded only by reductions in the benefit package. After much consultation with health professionals and public hearings and community meetings held throughout the state, the commission produced a list of almost 700 condition-treatment pairs grouped in 17 categories and ranked according to priority. According to the plan the Medicaid program would pay only for items above a certain cutoff point on the list, to be determined from time to time by the legislature. The plan was implemented in 1994 and has been politically popular among the general public and with Medicare recipients. As of 1998 it is limited to relatively poorer persons eligible for the state Medicaid program, and has not been extended to the general public. ...
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