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[...]
“Quality is the third leg of the three-legged stool of essential elements in health services
research and health care delivery. No evaluation of a health care system or discussion of
health care policy issues is complete without attention to it. One difficulty in the quality
area, as compared to the cost one, is that measurement is less clear and the U.S. health care
system not easily amenable to evaluation. No clear and complete consensus exists about how to
measure health care system outputs or quality. In part, this is due to a lack of clear
definition of health. The linkages between the health care system and the production of
health, even if one simplistically defines health as the reduction in the amount of death,
also is not always clear. Cost and quality issues are inextricably linked, but this paper
will start with a discussion of costs of health care and concerns related to costs and the
financing of health care.”
[...]
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[...]
“In 1989 Oregon became the first state in the nation to adopt legislation that would
explicitly ration health care for the poor. The Oregon Basic Health Services Act (OBHSA)
guarantees health care to all those who fall below the federal poverty level but limits
that care to what expert opinion, community sentiment, legislative judgment, and fiscal
reality deem a "basic level of services." In the words of the law's chief architect,
"Everyone will be in the health care lifeboat. Not everyone will eat steak, but at least
everyone will eat." The fact that it will be primarily the poor who will be deprived of
"steak" in the Oregon health care lifeboat is just one of many facets of the plan that
troubles its opponents. The Oregon rationing plan has left few observers neutral. It has
been characterized as "bold," "pioneering," "rational," a "brave medical experiment," and
"fundamentally flawed," "unfair," and "unethical." What proponents and opponents of the
Oregon law agree on is that the current "system" is seriously, and probably irreparably,
flawed. Something must be done to control spiralling health care costs and to expand access
to an estimated 32 to 37 million uninsured Americans. Where observers and participants
disagree is over the question of whether or not the Oregon plan offers a fair, workable,
and responsible solution.”
[...]
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