Value judgment in the Oregon Medicaid experiment.

Oregon proposed a unique social experiment in which combinations of medical conditions and treatments were prioritized. Under the proposed program, providers would not be reimbursed for services relevant to 17% of the condition-treatment pairs. The program was designed to expand access and allow significantly more residents to qualify for Medicaid. The original Oregon proposal used four levels of human judgment: community values assessed in town meetings; ratings of the desirability of health states; medical judgment of treatment efficacy; and subjective reordering of the list by Oregon Health Services Commissioners. In August 1992, the Department of Health and Human Services rejected Oregon's application to proceed with the experiment, objecting to the use of one of the four types of subjective data: ratings of the desirability of health states. A revised application that eliminated this one subjective component was approved in March 1993. This paper demonstrates that among the four levels of judgment, the ratings of health states were supported by the most evidence of reliability and validity. Implications for future prioritization experiments are discussed.