The value of health care: what can we learn from Oregon?

The scarcity of health care resources leads to rationing amongst potential users by one means or another. When the market is rejected, rationing should be conducted on the basis of systematic and informed priority setting. It has been widely suggested that these priorities should be based on health benefits measured by quality adjusted life years (QALYs) and recently the US State of Oregon has attempted to use QALYs for setting priorities on a large scale. Values not normally associated with QALY analysis were also incorporated in the process. Their unique experience is of interest in Australia, as no attempt has been made here to prioritize medical interventions on the scale that was undertaken in Oregon.