Article Abstract:
The Oregon Health Plan has succeeded in formulating a benefits package for all Medicaid recipients that is more precise than the plans of most insurance companies. In 1989, a commission mandated by the law which was passed that year ranked more than 700 diagnoses and treatments and decided not to cover any below line 587. The plan was approved by the Clinton administration in 1993 and implemented in 1994. All Oregon residents with incomes under the poverty level were enrolled in Medicaid, adding 100,000 uninsured people to the rolls. Most are in a managed care plan. The plan has been fairly well accepted by physicians and 88% of the patients are satisfied with the plan.
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Article Abstract:
Oregon's reliance on managed care to provide health care for its poor residents may serve as a lesson to other states. The Oregon Health Plan passed in 1989 enrolled many formerly uninsured residents in managed care plans. As Medicaid patients are enrolled in managed care, the managed care plans try to enroll the healthiest patients. This leaves city and county public hospitals to care for the sickest patients. Community health centers are also receiving smaller Medicaid reimbursements. When Oregon began charging enrollees premiums, many residents dropped out of the program.
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Article Abstract:
Doctors will still have to control health care costs no matter what type of employment arrangement they choose. Although managed care slowed the growth in health expenditures between 1993 and 1997, the trend may reverse. Many doctors and patients alike are becoming dissatisfied with managed care. If managed care premiums continue to increase, employers and employees will be unwilling to pay them. Doctors are joining unions and refusing to contract with some managed care plans. Some are even forming their own managed care organizations.
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