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Topics:
Health
Community
Meetings Shape Oregon Health Plan
Confronted
with the challenge of health reform, Oregon Health Decisions,
a nonpartisan grassroots group, convened hundreds of community
meetings throughout the 1980s to develop consensus on the basic
values that citizens felt should shape reform. These were used
to educate lawmakers, who then developed a reform process that
included such meetings as an essential part of public deliberation
on reforming Medicaid and extending coverage to the uninsured
. The highly popular Oregon Plan resulted from these initiatives.
Story and case studies plus.
Index
Story:
Citizens Create Dialogue on Values in the Oregon Health Plan
Case
Study Plus: Common Purpose in Health Policy: Report of Focus
Group Meetings, March 1994: a 33-page report by OHD that includes
an account of focus groups conducted by OHD to aid the Health
Services Commision in determining how citizens feel about 2 issues:
a) whether practice guidelines will be useful within the priorities
list established by the Oregon Plan; and b) whether availability
and access to some medical technologies should be regulated and
managed in a way that reduces cost and redundancy, or for other
reasons.
Case
Study Plus: A 10-page overview of Oregon Health Decisions
from its origins in the early 1980s through the community meetings
in 1990.
Contents
Story:
Citizens Create Dialogue on Values in the Oregon Health Plan
Citizens
Create Dialogue on Values in the Oregon Health Plan
Story
prepared by: Carmen Sirianni, editor-in-chief of CPN
A genuine
civic dimension in health involves citizens in creating and implementing
policy. Without this it is very difficult to develop policies
for which the public will claim ownership. If citizens are to
buy into reforms that effectively address the knotty questions
of universality of coverage, a basic minimum benefits package,
equitable funding, and freedom of choice, they need the opportunity
to deliberate together about what the values of equity, dignity,
and choice in health care really mean to them, as well as the
chance to consider various strategies and tradeoffs that they
might find reasonable in achieving these values.
Oregon Health Decisions (OHD) has pioneered in this, holding hundreds
of community meetings and two statewide health care parliaments
in the 1980s. These prepared the ground for a state reform process
beginning in 1989 that was triggered by the spiraling costs of
Medicaid and widespread public concern about who and what was
covered. The process continues today with extraordinary success
and support among the broadest array of local and state groups:
seniors and disabled, poor women and children's health advocates,
medical and nursing associations, insurance companies and small
businesses, and the hundreds of thousands of others who had previously
been left uninsured.
The Oregon Health Plan developed unusual bipartisan support, with
only five dissenting votes in both houses of the legislature combined,
and the Senate President John Kitzhaber, who spearheaded the reform
process, was subsequently elected governor. In less than two years
since the plan went into effect, some 35,000 people have left
the AFDC rolls, largely because they no longer need to be on them
to receive health coverage. And while there was loud opposition
from some national advocacy groups to the plan's priority setting
and rationing procedures under Medicaid, state reformers have
been addressing their concerns, and continuing to expand the already
high level of support for these procedures not only among the
general public, but among the very constituencies that some feared
would be most harmed.
There are various factors that account for this extraordinary
success. Not the least of these is that Oregon Health Decisions
had developed methods for getting citizens to deliberate respectfully
and responsibly at community meetings about those things they
value most in health care, and then convinced the legislature
to incorporate these and other methods of public deliberation
into the heart of the reform process. The community meetings identified
prevention, equity, community compassion, personal responsibility,
and cost effectiveness as key values. And they provided a good
sense of how citizens who are given a chance to deliberate about
these values together can confront the common sense reality that
they cannot have everything, especially in a high tech medical
culture, but must make sensible choices informed by shared values
and limits.
The Health Services Commission, with its consumer and provider
representatives, paid a great deal of attention to these community
meetings in its own public deliberations, and the legislature,
in turn, agreed to respect the priority setting process that emerged
from the latter.
More
information
Oregon Health
Decisions
821 SW 10th Avenue, Suite 203
Portland, OR 97205
Phone: 503-241-0744; 1-800-422-4805
fax: 503-241-0323
Mimi Luther, Executive Director.
e-mail: ohd@e-z.net
Michael Garland: 503-494-2554; fax:503-494-4981
e-mail: garlandm@ohsu.edu.
Center for Ethics in Health Care
Oregon Health Sciences University
3181 Sam Jackson Park Road, CB 669
Portland OR 97201-3098.
Dr. Ralph Crawshaw, M.D.: 503-233-8811.
Darren Coffman
Executive Director
Health Services Commission 255 Capitol St NE, Fifth Floor
Salem, OR 97310
Phone: (503)378-2422 x 413
e-mail: darren.d.coffman@state.or.us
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