19-64 underinsured final paper - Essay Example

ublic policy must take account of these cultural sensitivities, a willingness to recognize priorities and set limits seems to be proportional to the level of frustration with ever-increasing costs. 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. “Managed care has been the single most dominant force which has fundamentally transformed the delivery of health care in United States since the 1990s” (Shi, L. & Singh, D., 2004, p. 324). Once each year there is a major conference of representatives of the funds, the regional associations of physicians, hospitals, and pharmaceutical companies, to work out the contribution rate and other details for the underinsured.

The government does not provide any funding to the system but is very active in regulating and monitoring it. The basic features of the social-insurance-based health system have been adopted in many parts of the country. The welfare-oriented