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Biomedical subjects

J Oberlander

Publications and source records attributed to J Oberlander.

7 recordsLinked to original sources
PubMed2001

Rationing medical care: rhetoric and reality in the Oregon Health Plan.

The Oregon Health Plan (OHP) has been widely heralded as an important innovation in medical care policy and rationing. Oregon's pioneering method of prioritizing funding for health care through systematic and public ranking of medical services has drawn substantial international interest. This paper reviews the experience of the Oregon plan since it began operation in 1994. We argue that widespread misconceptions persist about the significance of the OHP. In particular, there is little evidence that the OHP has operated as a model of explicit rationing. In reality, Oregon has not rationed services, nor has its policy of cutting public coverage for services produced substantial savings. These findings have important implications regarding the desirability and feasibility of adopting a policy of removing items from the list of insured medicare services in Canada. Oregon's experience suggests that drawing the line on medicare coverage would be more difficult and less financially rewarding than advocates claim.

Health Care Rationing↗
PubMed1999

The Oregon Health Plan and the political paradox of rationing: what advocates and critics have claimed and what Oregon did.

The article proceeds in three sections. First, we very briefly review the original proposals and ensuing (and misleading) debate over rationing in Oregon. Next, we explore how the politics of rationing unfolded in Oregon from the enactment of OHP to its implementation. Finally, we consider the character of Oregon's innovation and the broader lessons that it holds for reform efforts elsewhere.

Diffusion of Innovation↗
PubMed1998

Remaking Medicare: the voucher myth.

There is growing enthusiasm for transforming Medicare into a voucher system. Advocates claim vouchers would increase the health care choices available to Medicare beneficiaries, reduce the regulatory burden on the federal government, and promote the benefits of fair market competition. In addition, some analysts contend vouchers are the only feasible solution to Medicare's short-term financing problems and the long-term "crisis" of the retirement of the baby-boom generation. The author argues against these claims. Vouchers would not work as advertised by proponents because of the limitations of risk-adjustment methods and unrealistic assumptions about consumer choice. Moreover, the elderly and disabled Medicare population is ill-suited to cope in a competitive insurance system. Implementation of vouchers would therefore pose a threat to both the health of beneficiaries and the stability of the Medicare program. The implications of this analysis for Medicare reform are discussed.

Choice Behavior↗
PubMedDate not supplied

Rethinking Medicare reform.

Many health policy analysts argue that demographic pressures, the inflationary nature of fee-for-service payment, and the uncontrollable nature of defined-benefit insurance make Medicare unsustainable in its current form. They assert that Medicare can remain fiscally viable in the next century only by embracing a voucher system and exposing beneficiaries to the economic consequences of their medical care decisions. We argue here, however, that Medicare need not rely on vouchers or on placing financial incentives on individual beneficiaries to control costs. Instead, we contend that Medicare can control expenditures the way most other industrial democracies do: through budgetary caps and centralized regulation of provider payments.

Aged↗
PubMedDate not supplied

Is premium support the right medicine for Medicare?

This paper assesses the desirability of transforming Medicare into a premium-support system. I focus on three areas crucial to the future of Medicare: cost savings, beneficiary choice, and the stability of traditional Medicare. Based on my analysis of the Bipartisan Commission on the Future of Medicare plan, I find substantial problems with adopting premium support for Medicare. In particular, projections of premium-support savings are based on questionable assumptions that the slowdown in health spending during 1993-1997 can be sustained and extrapolated to future Medicare performance. Consequently, premium support may inadvertently destabilize public Medicare and erode beneficiary choice without achieving substantial savings.

Actuarial Analysis↗