Healthcare Assignment: Case Analysis of Oregon Healthcare System

Question

Task: Critically review the Oregon Case Study (https://www.oregon.gov/oha/HPA/DSI-HERC/Pages/Prioritized-List.aspx), please prepare a healthcare assignment addressing the following:

• Are the prioritization processes and listings justified?
• Give examples of the positive and negative impacts on individuals and groups as well as the healthcare system when the list would be applied.
• How would you have approached the listing process including applying requirements for the administration of capped and uncapped budgets, benchmarking and effective practice outcomes?
• What would your priority listing have been, justifying your position supported by evidence?
• Discuss the implications of your analysis of the Oregon Case Study by comparing and contrasting with the Australian Healthcare system, making reference to the healthcare continuum and a healthcare environment with which you are familiar.

Answer

Introduction
The current healthcare assignmentanalyzes the case of Oregon Healthcare System that has been a benchmark in creating norms related to the prioritization of services for public health care. The reforms undertaken under this policy had brought a lot of controversies and debates in the world of healthcare systems and medical ethics. The main aim of this experiment undertaken was to expand the medical coverage of the familiar people by the state. How the different health services can be prioritized, and this attempt was often denoted as the first attempt to prioritize the list of health services in the world (Bauer, 2017).

Prioritization Process and Listing
The prioritization process was a very important attempt by the American health policy in reference to the Oregon case. It was an attempt to develop a very transparent method via which various medical services can be prioritized by implementing the different laws and regulations of the nation. The legislature of Oregon had approved a number of diseases, which will be treated as per their level of priority, and the cost of such treatment would be funded by the state only.

Such a list of prioritizations had also laid down the necessary guidelines for certain specific diseases, covering the age group, the type of screening covered under it, and the frequency of such diseases to be covered under treatment. For example, the first priority of treatment has been assigned to pregnancy. It has gradually moved on to various other diseases and their treatments in the order of sequence of priorities.

The main cause of developing such a list was to minimize the dependency of treatment on the insuring companies or on the private decisions of any individual, and more emphasis was given on public process development for the treatment of such cases. The list of priorities had included approximately 2000 procedures, and it was made available for the citizens of Oregon. This formed the crux of the Oregon Health Plan or OHP.

The listing was made keeping in mind the state population's health so that they can gain the maximum benefit by getting chances of treating such diseases by accessing the various treatments and preventive services for most major fatal chronic diseases like asthma, diabetes, hypertension, or depression. The list emphasized having lifesaving arrangements for treating conditions at a very acute stage from the individual point of view. These were given more importance in the list of prioritizations. However, at the same time a new method of prioritization was also developed by the commission of Oregon Health Services which focused more on the management of chronic diseases and also on preventive care measures so can the rise of such acute crisis situations can be checked at the very onset of the problem.

Positive and Negative Impacts of Listing
The application of this listing would have varied impact on the individual and group as well as on the healthcare system as well. The list was formed by members of a workgroup who had designed several principles to guide the use and utility of the listing. The positive impacts of the listing were to provide access to the care facilities universally at the basic level itself. Another impact was that it also showed society's responsibility for supporting the poor people of society by financing such treatment for them. Another very important result was to define the basic level of care through a public process.

The state's regulation designed the list in such a manner that it would help the physicians of the state work according to the prioritized list of health services. It would be very helpful for the physicians to determine which treatment services would be covered under the OHP, depending on the diagnosis of the patient's condition. The list would be used to identify the condition of the patient and what line of treatment should be followed as per the list.

The list, at the initial stage, was based on a method of cost-benefit analysis. It had some typical idiosyncrasies like the treatment of tooth caps were covered (Baicker, Allen, Wright, Taubman, & Finkelstein, 2018). On the other hand, appendicitis surgery was not covered, which would have a great impact both at individual and group levels. The process of incorporating the components of net cost was further used to alter the list. This leads to deriving all-encompassing categories from the guiding principles of the workgroup that would highly influence the process of decision making.

One of the negative impacts of this list was that the ways that were used to analyze the methods for making the prioritization list of health services were not enough to determine the treatments to be covered under it. It became not only a political problem but became an equal problem for the Health Service Commission as well (Hedberg, Bui, Livingston, Shields, & Van Otterloo, 2019). To address this issue, the commission had to use its authority to alter the treatment procedures.

The application of this list would have actually been now very helpful for bringing a very positive impact on the life of many people who had been hitherto deprived of the basic services of healthcare. This was one of the biggest achievements of implementing such a listing.

Approaching the Listing Process
Approaching the listing process, including applying requirements for the administration of capped and uncapped budgets, benchmarking, and effective practice outcomes, would require considering a lot of factors. The priority of approaching the listing process would always include those best ways which are to be adopted for achieving cost-effectiveness and clinical effectiveness for such an activity (Winthrop, et al., 2020). It would be required to consider the present placement of any service in the list or to find out that whether any new range of treatment would be needed to be added to the existing list or not. As for the factors of capped and uncapped budgets, efforts must be made to ensure that the resources of the state should be used in the most optimal manner so that costs can be kept well under control according to the plans and principles of the Oregon Health Plan so that maximum number of common people can get benefitted out of this. The priority would be to provide coverage to the maximum number of low-income citizens and abolish any disparities.

The capped budgets were mostly implemented due to the lack of control of state resources and also due to the limited availability of state resources. The listing process would hence be made to make the prioritization of medical services more useful for the common people and also to ensure the development of a public process. This would give the people more freedom from the insurance companies, and uncapped budgets would be released as the next step (Kushner & McConnell, 2019). Weighing the resource level of the state, uncapping of budget would be done to include more people under the realm of its benefit, but that might demand the curtailing if a few existing services that are already been provided at present. It must be made keeping in mind the sustainability of the medical budget of the state as well.

Priority Listing
The priority listing according to my choice would have been more or less in the same line only. I would have rather make it all-inclusive by including any other disease or ailment that has been left out of this list. For example, as mentioned in the paper tooth capping has been included, but emerging appendicitis was not covered. Such exclusions need to be changed at priority (Bailit, Friedberg, & Houy, 2017). My recommendation for changing the priority listing would be backed up by necessary annual updates. Such updates would help to add or alter the diagnosis and code of procedures that can prove to be very helpful in identifying the pairs of condition treatment (Stock & Goldberg, 2017).

The listing should also be done keeping in mind that priority is health and not just health insurance services. I would like to portray me as a representative of the numerous common people who are in dire need of such a health program. The listing must be made keeping in mind that the development of the health service should be explicit in nature. If needed, the benefits provided may be minimized, but such a reduction should not be allowed to take place in the listing by reducing the number of people covered under it.

The main strategy of formulating such listing would be to remove the practice of rationing by which people gets excluded from the benefits of health coverage, and the entire process of listing should be made public and would be fully accountable to the public as well. Chronic diseases having acute syndromes and fatality rate would be given more priority while listing. This would include diseases like diabetes, hypertension or asthma. In addition to that the listing should also include diseases having least or zero fatality and which are not labelled as life threatening diseases. One of the main examples of such condition is related to childbirth and similar type of less impactful criticalities (Kroening-Roche, Hall, Cameron, Rowland, & Cohen, 2017).

OHP Vs Australian Healthcare System
In comparison to this system, the Australian healthcare system is one of the leading systems in the world. It can be vouched by the fact that Australians are having one of the longest expectancies of life in the entire world. The healthcare providers in Australia include medical specialists, general practitioners, nurses, and allied health workers as well. Just like the Medicaid program in Oregon, Australia also has its very own scheme of universal healthcare that is termed as Medicare. Both Medicare and systems of public hospital offers access of treatment to all Australians either low cost or free of cost.

As a program of the Australian government, the healthcare environment of Australia ensures that Medicare covers all the costs related to the services of public hospital (Callander, Shand, Ellwood, Fox, & Nassar, 2020). In addition to those various costs related to some other type of health services are also covered under this. Australia has already ensured that meet the defined requirements of health coverage as mentioned by WHO. This includes making quality health services accessible to everyone, and financial protection is made available for everyone who wants to use such healthcare facilities of the nation. On this parameter, the US has not been able to qualify as a nation whose healthcare system is approved by WHO.

The OHP has been a movement from private to public platform, the same is applicable for Australian healthcare system as well where a 2-tier system exits, that includes both private and public. The hospital care facilities offered in Australia are of extremely high quality and is applicable and accessible to the permanent residents, all other citizens and some specific category of visa holders as well. Such facility includes both outpatient and inpatient hospital care for the public and that too without any cost. There are options for availing private treatments as well in which the patient has to bear the cost out of his pocket.

To bear such a huge cost of medical services all Australians need to pay a 2 percent levy on their income tax, and even an additional 1 percent is charged for those high-income group members of the society who decides to opt-out of any private coverage. The framework of Australian healthcare systems strongly supports coordination between primary and secondary parts of the healthcare continuum that includes specialist care for sectors related to sub-acute, non-acute and acute sectors like aged care, disability, indigenous health services, and early childhood (Pizzirani, O'Donnell, Skouteris, Crump, & Teede, 2020). The healthcare system as mentioned in reference to the OHP was a program meant specifically to cover the low-income group and the senior citizens. The cost of such coverage was totally sponsored by payroll taxes of the US. As a result of which majority of the population was left out of the coverage, and they had arranged for their expenses of healthcare without any support from the Federal government of the nation.

Conclusion
It can be inferred from the above discussion that the OHP had been a revolutionary effort undertaken by the US government at that point of time which was primarily aimed at providing quality service of healthcare to the economically challenged population of the society. The noble objective of the project has already made it a precedence in the global healthcare scenario.

References
Baicker, K., Allen, H. L., Wright, B. J., Taubman, S. L., & Finkelstein, A. N. (2018). The effect of Medicaid on dental Care of Poor Adults: evidence from the Oregon health insurance experiment. . Health services research, 53(4), , 2147-2164.

Bailit, M. H., Friedberg, M. W., & Houy, M. L. (2017). Standardizing the measurement of commercial health plan primary care spending. . Milbank Memorial Fund.

Bauer, J. (2017). House GOP Health Plan Threatens Nearly One Million Oregonians Relying on the Oregon Health Plan. OCPP.

Callander, E., Shand, A., Ellwood, D., Fox, H., & Nassar, N. (2020). Financing maternity and early childhood healthcare in the Australian healthcare system: costs to funders in private and public hospitals over the first 1000 days. . International Journal of Health Policy and Management.

Hedberg, K., Bui, L. T., Livingston, C., Shields, L. M., & Van Otterloo, J. (2019). ntegrating public health and health care strategies to address the opioid epidemic: the Oregon Health Authority's Opioid Initiative. Journal of Public Health Management and Practice,.

Kroening-Roche, J., Hall, J. D., Cameron, D. C., Rowland, R., & Cohen, D. J. (2017). Integrating behavioral health under an ACO global budget: barriers and progress in Oregon. . Am J Manag Care, 23(9), , e303-e309.

Kushner, J., & McConnell, K. J. (2019). Addressing Social determinants of health through medicaid: lessons from oregon. Healthcare assignmentJournal of health politics, policy and law, 44(6), , 919-935.

Pizzirani, B., O'Donnell, R., Skouteris, H., Crump, B., & Teede, H. (2020). Clinical leadership development in Australian healthcare: a systematic review. . Internal medicine journal, 50(12), , 1451-1456.

Stock, R., & Goldberg, B. W. (2017). Health reform policy to practice: Oregon’s path to a sustainable health system: a study in innovation. . Academic Press.

Winthrop, K. L., Marras, T. K., Adjemian, J., Zhang, H., Wang, P., & Zhang, Q. (2020). Incidence and prevalence of nontuberculous mycobacterial lung disease in a large US managed care health plan, 2008–2015. . Annals of the American Thoracic Society, 17(2),.