The Oregon priority-setting exercise: quality of life and public policy

In 1989 the Oregon State legislature passed the Oregon Basic Health Services Act, which created a Health Services Commission charged with "developing a priority list of health services, ranging from the most important to the least important for the entire population to be served." The goal of this legislation was to permit the expansion of Medicaid to 100 percent of all Oregonians living in poverty by covering only services deemed to be of sufficient importance or priority...Instead, the OHSC developed a set of seventeen health service "categories," which described either a specific type of service...or, more generically, the expected outcomes of care... Commissioners formally ranked these seventeen categories in order of importance according to three subjective criteria: value to the individual, value to society, and whether the category seemed "necessary." Each treatment was then assigned to the single most appropriate category, based on Commissioners' judgment. Services were ranked within categories according to the degree of benefit expected from treatment... Estimates of how treatments affect quality of life were by far the single most important factor in determining the priority order on that list....