University Daily Kansan / Friday, May 4, 1990
13B
Oregon debates medical rationing
Months of research will determine limits in state health care
The Associated Press
SALEM, Ore. — Life-and-death questions once left to God and the family doctor soon may be answered in Oregon by legislators who have been privatized, cost-analyzed printout of alimenties and treatments.
The printout, ranking the relative benefits of 3,000 medical procedures, was completed this week after months spent by researchers determining how Oregonians get sick and injured.
During the next two weeks, members of the legislative committee will weigh aspects such as quality of life, personal choice and the community's sense of compassion, said Paige Sipes-Metzler, chairman of the 11-member panel. On May 15, it will factor together these criteria with a cost-benefit analysis to make a final report.
The next step is for legislators to take the list, search their souls, and draw a line. Above the line will be illnesses covered by the state's Medicaid program for the poor. Below it will be ailments the poor must live with and, sometimes, die with.
Welcome to medical rationing, Oregon style.
Proponents say it is a necessary evil in an age of limited budgets and $200,000 liver transplants. And Oregon's high-tech approach is being watched closely by other states facing the same high-tech question: Can we afford the miracles of modern medicine?
"We can transplant hearts and lungs and livers and parts of the pancreas. We can do far more with trauma victims than ever before," said Connie Thomas of the Intergovernmental Health Policy Project, a research group in Washington, D.C. "But deciding how to use
those technologies in a fair and cost-effective way has eluded us all."
The glowing success of organ transplants, for instance, is tarnished by the fact that nearly all patients first undergo "wallet biopsies" to determine whether they can afford the costly surgery.
Every wonder drug or surgical breakthrough raises uneasy questions about who will be excluded. Should society pay to transplant a chronic alcoholic's damaged liver even though he will go through the new one in a couple years? Should a bedridden 90-year-old person get triple-bypass heart surgery even though other aliments likely will kill her within a year? What if she is 60?
Not just the poor
Once, only the poor had to worry about being locked out of health care. But as medical costs rise, many middle-class citizens are feeling poor when the time comes to pay the doctor. Some facts about
U. S. health-care spending this year is expected to exceed $600 billion, or about 12 percent of the gross national product, up from 7 percent in 1970, federal health officials said.
Some 31.5 million people, or 13 percent of all citizens, have neither health insurance nor Medicare coverage, the Census Bureau reported.
Even citizens with company health plans are being asked to pay more. And those plans may decrease in value as insurance companies ponder dropping costly procedures from standard coverage.
Issue for the '90s
Medical rationing looms as a dominant health-care issue of the 1990s, as U.S. citizens realize after decades of revolutionary medical advances that there are no miracles, just hard choices.
"Health care is a world of limited resources and infinite demand," said Arthur Feinberg, regent of the American College of Physicians. "It comes down to a question of who lives, who dies and who decides."
Doctors avoid the debate about who decides, saying their allegiance is to the individual patient regardless of society's cost.
Congress may seem a logical place to tackle the issue, but miracles are not likely there either. National health care long has been batted about Washington, but the estimated annual price tag of $65 billion dampens enthusiasm.
For now, the issue of health care sits with the states. Nowhere does it sit more heavily than in Oregon, the first state in the country to consider limiting the types of conditions that will be paid for by Medicaid.
Oregon's battles
The Oregon story began in 1897, when a cash-strapped Legislature halted Medicaid financing for most organ transplants, saving the money for other health needs such as prenatal care. Only two other states, Virginia and Arizona, exclude transplants.
Oregon's decision drew little notice at first. Then, Coby Howard, a 7-year-old leukemia victim, died as his family tried to raise
contributions for a bone marrow transplant.
Suddenly health care allocation was an issue, kept alive by a stream of publicized hardship cases. Advocates for transplant patients and the poor demanded a new way of distributing state Medicaid dollars. In June 1989, the Legislature gave them one.
It was less — and more — than they expected.
Legislators tackled a basic inequity in the state-federal Medicaid program. Congress designed Medicaid to provide health care to the poor, but millions of poor people do not qualify.
Oregon decided to expand its 60 percent coverage to 100 percent of the poverty level, adding as many as 120,000 people to Medicaid rolls. The Legislature also passed a bill to provide basic health insurance.
Oregon's plan
The idea was to stop rationing people out of health care and start rationing services instead. The policy was a way to decide which services to cut.
The newly created Oregon Health Services Commission conducted 61 public meetings. More than 50 committees of medical specialists compiled thick reports, listing ailments along with the cost and effectiveness of treatments. A telephone survey asked Oregonians to rate illnesses in terms of how they would impair their lives. The ratings range from death at zero to perfect health at 100.
This mountain of data was crunched into a complex formula, and an all-night computer run produced a list of costs and benefits for treating 3,000 illnesses, ranging from appendicitis to herpes.
New developments keep rural doctors in step with trends
The Associated Press
LUBOCK Texas — Like most doctors, William Isaacs wants to keep up with discoveries and refine his technique.
But he lives in Canadian, a Pan handle town on the south bank of the Canadian River, 100 miles northeast of Amarillo. The region's dark red soil supports farms and roads. Oil pumpjacks do the landscape.
science.
It's not the kind of place where doctors gather at conventions to discuss the latest news in detecting breast cancer or treating hypothermia.
"Out here in Canadian, it's such an obstacle to travel out and get continuing education," said Isaacs, a family practitioner. "You have to leave your practice, hand it over to another doctor, and then bring it." It's almost too much trouble.
"It works really well," said Carl Utterback, a family practitioner in Seminole. "I can see patients in the morning, and I can walk over to the hospital and have lunch, and eat lunch." In fact, I can absorb a few facts.
Doctors in the program, called MEDNET, talk in front of cameras in a studio at Texas Tech. The television station reports videos still available to rural hospitals at lunch time.
But a program sponsored by the Texas Tech Health Sciences Center in Lubbock is using satellite television to bring continuing education to doctors in Canadian and nine other rural West Texas towns.
"It's a one-way video, but a two-way audio, so they talk back, make comments, ask questions," Ted Hartman, MEDNET user.
'I can see patients in the morning and I can walk over to the hospital and have lunch, and while I'm eating lunch, I can absorb a few facts.'
— Carl Utterback family practitioner
Hartman is optimistic that the network, which began the educational programs in December, will be expanded to the rest of the state.
The satellite TV programs are only one facet of MEDNET, a three-year pilot program financed by a $1.9 million grant from the U.S. Department of Health and Human Resources from Texas Tech and a donation of $170,000 worth of communications equipment from AT&T.
MEDNET also placed facsimile machines and computers in rural hospitals so they could receive documents quickly from medical school libraries. But doctors found that they could send printouts of ultra-resistant monitoring data to distant patients. Two rural women were taken to city hospitals to deliver babies because of problems detected on the fetal printouts, Hartman said.
A MEDNET computer network among rural hospitals allows them to save money by buying supplies from the hospital. How rural hospitals to quickly send medical records to city hospitals when patients are transferred
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