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A Guide to Health Care in Oregon |
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We all know what the problem with health care is in our country: Cost. Time magazine devoted an entire issue in February 20, 2013 to the cost of health care in the USA. It is good reading and perhaps the most comprehensive review of health care ever written up in a magazine and it’s all about the high costs of health care. Titled “Bitter Pill: Why Medical Bills are Killing Us,” and unless you subscribed to Time you will have to read it at the library as they have taken it offline at their Web site. Judging the quality of hospitals and professional health care providers is difficult. Today, you can get more information about choosing a computer or smartphone than choosing a doctor or hospital. Oregon Noted for Innovation and Low Cost Health CareOregon has two decades of pioneering Medicaid reform work, much of it under John Kitzhaber. In the early 90s, Oregon received a widely noted federal waiver to cover all residents earning up to 100 percent of the poverty level by limiting benefits to services that had demonstrated clinical effectiveness and value. Then, in 2003, with Kitzhaber in his second term as governor, the state again expanded the Oregon Health Plan–the state’s name for its Medicaid program–to cover pregnant women and children in households earning up to 185 percent of the poverty level. Statehealthfacts.org calculated the per enrollee Medicare spending at $8,247 for Oregon in 2011. The national average was $10,365 per Medicare enrollee. Statehealthfacts.org is a project of the Henry J. Kaiser Family Foundation and is designed to provide free, up-to-date, and easy-to-use health data for all 50 states. Regional variation in Medicare spending is striking. Among the 306 hospital referral regions in the United States, Medicare reimbursements varied more than threefold in 2007, from about $5,200 per enrollee in the lowest spending region to more than $17,000 in the highest spending region. From 1992 to 2006, total Medicare spending grew at an average rate of 3.5% per year, but this growth was not also spread evenly across regions. The rate of average annual growth varied from a low of 1.6% in Honolulu to a high of 8.3% in McAllen, Texas. The Dartmouth Atlas Web site has an excellent tool for determining Medicare costs — you can customize reports and pull up some interesting numbers. Oregon Public Health DivisionThe Oregon Public Health Division collects and analyzes data on health behaviors, diseases and injuries, disseminates findings, and designs and promotes evidence-based programs and policies to improve the health and safety of all Oregonians. The Oregon public health system comprises federal, state and local agencies, private organizations and other diverse partners working together to protect and promote the health of Oregonians. An essential function of the Oregon public health system is to provide data and information about the health of Oregonians. Most of the information about the frequency of or risk factors for deaths, illnesses and injuries across the state comes from the public health system's "surveillance" activities. The data sets and documents spotlighted here represent the work of the various programs conducting these surveillance activities. See Oregon's State Health Profile (PDF) for a broad set of indicators that offer a snapshot of the health of people in Oregon. Health Care Regulation and Quality ImprovementThe Health Care Regulation and Quality Improvement (HCRQI) program ensures that Oregonians have wide access to the health care they need and that it will be safe and of high quality. HCRQI regulates health care facilities, providers and suppliers in acute care and community-based programs. These include hospitals, home health agencies, in-home care agencies, hospice programs, ambulatory surgical centers, rural health clinics, special inpatient care facilities, end-stage renal disease dialysis facilities, birthing centers, rehabilitation agencies and clinics, comprehensive outpatient rehabilitation facilities, community mental health centers, hemodialysis technicians and portable x-ray suppliers. Oregon Gets an "F" for Health Care TransparencyOregon and 28 other states do so little to inform consumers about the cost of medical procedures that they deserve an “F” for health care transparency, according to a report released in March 2013. Transparency is a much talked about topic these days, with articles and documentaries increasingly focusing on seemingly inexplicable costs — usually hidden ones — for a variety of medical procedures. It’s a favorite topic of businesses and insurers who contend making more information public will drive prices down in ways that recent health reform laws do not. Only 14 states get a C or better. Just two states, Vermont and Massachusetts, get an A, and that’s because the group gave a curve, according to the report. It cited research showing the cost of procedures can vary by 700 percent in a given market. "States can play an important role in ensuring that consumers have access to both quality and price information by setting policies and implementing laws that advance transparency. The most comprehensive, consumer-friendly laws ensure ready access to information and data about a broad range of providers and services," according to the report, which was produced by the Health Care Incentives Improvement Institute and the Catalyst for Payment Reform. Affordable Care Act (aka Obamacare)Health insurance exchanges outlined in the federal Affordable Care Act are regulated online marketplaces for state residents to comparison shop for coverage. Congress called for their nationwide establishment by 2014. The federal health care overhaul required all 50 states to have an exchange where small businesses and uninsured individuals can shop for health coverage and access federal subsidies. Key features of the law are these rules:
Oregon and Washington are among the first six states to get preliminary approval from the Obama administration to operate health insurance exchanges, the U.S. Department of Health and Human Services (HHS) announced in December 2012. All have Democratic governors and were the first of 14 states to submit their plans to operate an exchange, reported The Hill's Healthwatch. Because the six states have made sufficient progress building their online marketplaces, HHS granted them conditional approval to begin enrolling members in October 2013 and coverage will begin on January 1, 1014. Oregon's insurance exchange is being marketed as Cover Oregon. Federal officials say Oregon's application was given conditional approval because the state hasn't completed all required actions. The Cost of Insurance Under the ActInsurers and state officials are bracing for major upheaval for more than 200,000 Oregonians who buy their own insurance. Insurers' rate requests for 2014 will be announced in May or June of 2013. The general outlines are clear: Under the new federal health law, the reasonably well-off can expect to pay higher premiums in the individual market, especially if they're 49 or younger. For many of the rest, there's good news: Costs of coverage will drop significantly thanks to tax credits. But important details remain to be worked out, including how big a role age plays and specific rate hikes. The coverage cost shake-up for those purchasing their own coverage is just one of many major changes to the health care landscape rolling out this year courtesy of the Affordable Care Act. Currently about 200,000 Oregonians purchase their own insurance. More than 70,000 more of them are expected to purchase individual insurance next year, with more signing up in years to come. Oregon's incoming health insurance exchange could serve as many as 471,000 state residents by 2016. In early 2013, Rocky King, the Oregon Health Exchange's executive director, acknowledged that the estimate is at the high end but said the figure is realistic. The exchange is a federal health reform-driven initiative that aims to provide a transparent marketplace for small business and individual insurance buyers. King said as many as 357,000 Oregonians could utilize the exchange's services by 2015, or the end of its first full operational year. King revealed the estimate at a meeting of Cover Oregon, the state group that will oversees the exchange. Affordable Care Act: Comparing Physicians, Hospitals, Nursing Homes, Home Health Agencies, and Dialysis FacilitiesThe Affordable Care Act is designed not just to control health care costs, but also to improve quality of care. The federal government has created several tools that allow you to compare a variety of quality measures of health care and service providers. In addition, the Partnership for Patients program highlights hospitals and other providers that have made a commitment to reducing medical errors, improving health care quality, and reducing costs. The Affordable Care Web site has a complete page where you can compare. Here is the list:
Oregon Health Plan: The State's Medicaid Program
It was intended to make health care more available to the working poor, while rationing benefits. This meant that Oregon was one of the earliest states to end payments for unnecessary non-therapeutic circumcision. Oregon uses a list of hundreds of conditions and their treatments and higher priority is given to conditions that can be successfully treated. In 1994, the plan's first year of operation, nearly 120,000 new members signed up, and bad debts at Portland hospitals dropped 16%. The plan's costs increased from $1.33 billion in 1993-1995 to $2.36 billion in 1999-2001. Significant cuts were made to the Oregon Health Plan's budget in 2003. New enrollment in the program was closed from mid-2004 until early 2008, when a lottery-based system was introduced. Tens of thousands of Oregonians signed up, competing for 3,000 new spots in the plan. The winners were picked from roughly 50,000 names of uninsured, low-income adults whose income qualifies them for the Medicaid program. In late 2012 Governor John Kitzhaber proposed to add at least 160,000 people to the Oregon Health Plan — but his budget has to get through the Legislature first. In early 2013 the U.S. Supreme Court ruled on the federal Affordable Care Act, saying it's up to each state whether they use the new law to expand Medicaid — which includes the Oregon Health Plan. Under the law, eligible incomes would jump from 100 percent of federal poverty level to 133 percent, or $30,656 for a family of four. Under the law, the federal government picks up 100 percent of health care costs at first, leaving Oregon to pay only for administration. By 2020, the federal government's share ratchets down to 90 percent. A recent report by the Urban Institute for the Kaiser Family Foundation pegged Oregon's expansion costs at $506 million over 10 years, but said it could also reduce government costs of providing other free care by $280 million. There are *665,000 people currently in the plan as of late 2012. If the plan is expanded another 225,000 would most likely be covered. There are 130,000 already on the waiting list. The projected increase in the state OHP expenditures over 10 years is estimated to be *$506 million and the projected increase in federal OHP expenditures over 10 years would be about $12.8 billion. *Numbers are rounded and some enrollment numbers fluctuate month to month. First three numbers are from Oregon Health Authority and the dollar figures are from Kaiser Family Foundation. Controversy over RationingThe Oregon Health Plan became the focus of national scrutiny in 2003, after deep budget cuts led to 100,000 people in mental health and/or substance abuse treatment losing prescription coverage under the program. During 2008 and 2009, the Oregon Health Plan stirred up controversy when enforcing 1994 guidelines to only cover comfort care, and not to cover cancer treatment such as chemotherapy, surgery and radiotherapy for patients with less than a 5% chance of survival over five years. Springfield resident Barbara Wagner said her oncologist prescribed the chemotherapy drug Tarceva for her lung cancer, but that Oregon Health Plan officials sent her a letter declining coverage for the drug, and informing her that they will only pay for palliative care and physician-assisted suicide. She appealed the denial twice but lost both times. Tarceva drugmaker Genentech agreed to supply her the $4000-a-month drug free of charge. Wagner's plight garnered a flurry of attention from the media and triggered protest from religious groups. Wagner died in October 2008. A New Way: Coordinated Care Organizations (CCOs)Starting in 2012, Oregon Health Plan clients have a new type of health plan called Coordinated Care Organizations or CCOs. A CCO is a network of all types of health care providers who are working together for people who receive health care coverage under the Oregon Health Plan. CCOs integrate physical, mental and eventually dental care with the goal of better health, better care and lower costs. CCOs focus on prevention of illness and disease and improving care to keep patients healthy and to manage existing health conditions. Medicaid patients will now get all their care through a regional CCO. The CCO brings together doctors, hospitals, mental-health workers, even competing managed-care insurers. It gives them a single per-patient budget to coordinate care. Most important, the new CCOs will target the highest-cost patients — the ones with chronic conditions like heart disease and diabetes. It’s these people who end up in the hospital again and again. A new accountability plan reached with the federal Centers for Medicare and Medicaid Services in late 2012 sets rules for state officials as they use the five-year funding pact to try better coordinate care for more than 600,000 low-income members of the Oregon Health Plan. The broad outline of OHP reforms were approved by lawmakers in 2011. The state is handing off many spending decisions to CCOs that integrate mental, physical and dental health, with a hefty dose of prevention to cut down on costly emergency visits. Under the "Accountability Plan and Expenditure Trend Review" announced in late 2012, Oregon agrees to curb the health plan's per-member spending growth to 3.4 percent over the final three years of the pact. There are also quality goals to assure federal officials the state doesn't sacrifice care to rein in spending. Measures include customer satisfaction, use of electronic health records, and success in enrolling people in primary care homes that improve chronic disease care. Oregon must pay hefty financial penalties if it doesn't meet the spending and quality goals. For more information on the new accountability plan, see the state's Web site. Resources
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Health Care Coverage As of late 2012 there are about 600,000 Oregonians who do not have health care coverage. At the time, Medicaid covered 240,000 Oregonians.The Economic Policy Institute, a non-profit, non-partisan think tank found that about 58 percent of U.S. companies offer health coverage — down almost 11 percent since 2000.Oregon companies do a little better, with about 59 percent offering their workers health coverage.
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Like most metropolitan areas in the USA, the Portland area has a comprehensive array of health care facilities and medical specialists. This includes an university with a medical and dental school and a hospital. Also a children's hospital and veteran’s hospital.
