Question

Describe the Oregon Health Plan including its history and development; then evaluate the successes and failures of the plan. (25 points) (A 1½-page response is required.)

Answer 1

Oregon Health Plan

The Oregon Health Plan is a program that pays for low- income Oregonians' healthcare. The state of Oregon and the US Goverment's medical program pay for it. It covers different groups of services and it is called benefit packages and it is overseen by The Health Authority of Oregon. In other words, Medicaid is a federal program that is managed by each state to provide health insurance some low income individuals and provided by a program called Oregon Health Plan.

History and Development

• The plan was introduced and accomplished by Jhon Kitzhaber and Dr Ralph Crawshaw in 1993,intended to   make the health care more available to the poor.
• In March 1993,President Bill Clinton approved the plan.
• In 1994,nearly 120,000 new members enrolled to the plan.
• Increased cost of the plan from $1.33 billion to $2.36 billion leads to budget-tightening measures in the year 2000 and followed by significant cuts in 2003 and new enrolment in the program was closed from the middle of the year 2004 to early 2008.
• In 2008,Oregon Health Authority started to introduce changes in medical policy to increase screening rates and to provide more access to services for young children at risk of developmental disorders.
• The plan was able to insure 80,000 uninsured children through a legislation passed in 2009, and there are more than 100,000 children enrolled by the year 2012.
• In 2011,transformation of the plan was initiated by Oregon House Bill and signed into law by governor ,focussed on prevention and coordination of physical, mental and dental care for insured clients, since 2012, the plan clients have a new type of health plan called Coordinated Care Organizations or CCOs.
• CCO is a network of all type of health care providers(physical, mental and eventually dental), who are working together for people who receive healthcare coverage under the Oregon Health Plan and integrates better health in high quality and with low costs.

Evaluation of success and failures.

1. The Oregon Health Plan was called a 'bold experiment'.
2. It sought simultaneously to expand coverage,control costs, and foster provider participation.
3. The Oregon Health Plan has produced results that are not significantly different from the outcomes seen by the U.S. as a whole.
4. Over the life of the plan, the share of uninsured in Oregon has not been significantly different from the rest of the U.S. for any sustained period of time. Similarly,over time, the share of the population covered by plan is virtually no different from the rest of the U.S.
5. Total Medicaid expenditures and Medicaidexpenditures per enrollee have closely tracked U.S.expenditures, an indication that the Oregon Health Plan has not been any more or less successful than the U.S. as a whole in controlling costs.
6. Initial hopes for broad participation by providers have been dashed by the pullout of larger managed care providers and a shrinking pool of providers willing to acceptOregon Health Plan enrollees as new patients.
7. The result is aunique state health care bureaucracy that has achievedapproximately the same outcomes that a less ambitious programlikely would have achieved.
8. As Oregon currently looks for ways to “reset” state government,the bold experiment of the Oregon Health Plan should be scrutinized.
9. A program offering health savings accounts toOregon's Medicaid eligibles is one way that Oregon might meetmany of the goals of the Oregon Health Plan at a lower cost andwith smaller demands on administrative overhead. In addition tohelping the state get out of the health care management business,a program of health savings accounts will save money by makingthe insured more sensitive to the expected costs and benefits of health care services.
10. It will give them an incentive to manage their health care spending in such a way that it balances spendingon preventive care in the near term against the possibility of spending on acute care in the future.
11. The accounts are part of a five year pilot program that allowsMedicaid eligibles to manage the cost of their Medicaid services.The accounts have the effect of rewarding the enrollee for enrolling in managed care, staying healthy, and obtaining preventive care.
12. Under the plan, the state places a set amount of funds ($2,500 for adults and $1,000 for children) in the accounteach year the participant is enrolled in the program. As the enrollee receives Medicaid-covered services, the cost of the careis deducted from the account. Funds can be used for Medicaid-covered services only. Payments from the account are madedirectly to the Medicaid-enrolled provider.
13. The costs of  preventive care, such as an adult's physical or child's well care or immunizations, are not deducted from the account. If the enrollee spends all the money in their account before the end of the year,the enrollee pays an out-off pocket deductible ($250 for adult and$100 for child).
14. When an enrollee with an HOA is no longer eligible for Medicaid, most of the funds left in the account can be used for job training, education or other health care expenses.The money, however, is never available to the enrollee towithdraw in cash.