NCPA - National Center for Policy Analysis


February 19, 2009

Apparently, the Oregon Health Plan is the first government health care program anywhere in the world that has drawn up a formal procedure for rationing, says Linda Gorman, a senior fellow with the Independence Institute.  After comment from interested parties, this state health program for low-income people ranks treatment for various diseases and conditions, currently from 1 to 680, in order of priority. 

The health care dollars available determine which priorities are met.  As program costs have grown, the list of covered procedures has become shorter, says Gorman. 

Surprisingly, between 2002 and 2009 there was a fairly radical reordering of priorities. That is, procedures that were in the middle of the pack in 2002 climbed to the top of the list in 2009, and vice versa.  A great many life-saving procedures that ranked high in 2002, such as treatment for Type 1 diabetes, have been relegated to a much lower position in 2009, while procedures that are only tangentially related to life and death have climbed to the top.

As of 2009, the rapid and complete treatment of medically correctable problems and diseases has taken a back seat to routine and preventive care.  For instance:

  • Bariatric surgery for people with Type II diabetes and a 35 or greater Body Mass Index (BMI) number is ranked 33rd.
  • This means that the rationing board thinks that stomach surgery to control obesity is more important than surgery to repair injured internal organs (88), a closed hip fracture (89), or a hernia showing symptoms of obstruction or strangulation (176).
  • Abortions rank 41st, indicating that the state considers using public money for abortions more important than treating an ectopic pregnancy (43), gonococcal infections and other sexually transmitted diseases (56), or an infection or hemorrhage resulting from a miscarriage (68).

In 2002, when treatments through 566 were funded, there was far more emphasis on actual medical care and measurable interventions that save lives and improve individual functioning, says Gorman.  Various interest groups have spent the last seven years reordering the political priorities embodied in the list.

Source: Linda Gorman, "Rationing Care: Oregon Changes Its Priorities," National Center for Policy Analysis,

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