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Oregon's Medicaid Ranking and Cost- Effectiveness

Is There Any Relationship?

Gregg Meyer, MD

Joanna E. Siegel, ScD

Joseph S. Pliskin, PhD

John D. Graham, PhD

Milton C. Weinstein, PhD

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)

Medical Decision Making, Vol. 16, No. 2, 99-107 (1996)
DOI: 10.1177/0272989X9601600201


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