Oregon's Medicaid Ranking and Cost- Effectiveness

Abstract

The authors examine whether Oregon's 1990, 1991, 1992, and 1993 prioritized lists were ranked in a manner consistent with cost-effectiveness. Two sets of cost-ef fectiveness data are used: data from economic analyses and Oregon's own cost- effectiveness data. Comparing the ranks of Oregon's lists with the ranks of cost- effectiveness estimates from the literature reveals Spearman correlations of -0.08 for the 1990 list, +0.39 for the 1991 list, +0.25 for the 1992 list, and +0.24 for the 1993 list. Comparing Oregon's lists with Oregon's own cost-effectiveness data reveals rank correlations of +0.99 for the 1990 list, +0.06 for the 1991 list, -0.05 for the 1992 list, and -0.03 for the 1993 list. Thus, there appear to be essentially no relationship be tween the 1990 list and cost-effectiveness estimates from the economic literature and modest positive relationships between the 1991-93 lists and the literature. In addition, there is virtually no relationship between the 1991-93 lists and Oregon's own cost- effectiveness data. Further, the correlations are very different from +1.0, suggesting that other factors are at play. For example, the 1993 list that is currently being imple mented was ranked primarily by improvement in five-year survival and human judg ment, not cost-effectiveness. Key words: Oregon; Medicaid; cost-effectiveness; ra tioning ; resource allocation. (Med Decis Making 1996;16:99-107)