check mark on seesaw with X on other side
By IHPL - December 1, 2023

As one who was born in Salem, Oregon, I have an enduring interest in what happens in my original “home state.” An example I have found especially fascinating is the way Oregon has approached the challenging task of prioritizing healthcare for those who have coverage through Oregon’s Medicaid program, known as the Oregon Health Plan (OHP).[i]  The OHP was made possible because of a federal provision in Medicaid that allows states to seek waivers of some requirements in order to attempt creative approaches that may enhance achievement of Medicaid’s goals.[i] Oregon obtained such a waiver in 1994.

For nearly thirty years, Oregon legislators have established a global budget for the OHP and publicized a ranked list of condition/treatment pairs, with the most valuable treatments at the top of the list and the least valuable at the bottom. Currently, the list has 662 such pairs. The most valuable treatment, according to the list, is “maternity care” for pregnant persons. The least valuable are treatments that “have no clinically important benefit or have harms that outweigh benefits.” The Oregon State Legislature decided to fund down to condition/treatment 472 which is “acquired ptosis and other eyelid disorders” for which medically indicated “ptosis repair” is the treatment.

All systems of healthcare have to make at least three types of allocation decisions:

  1. Micro-allocation decisions about which persons with which conditions get which treatments. The triage decisions about which patients to give priority for intensive ventilatory care during the COVID-19 pandemic is a memorable example.
  2. Macro-allocation decisions about which treatment modalities to include in the system. OHP’s ranked list is one publicly visible example.
  3. Mega-allocation decisions about how much funding to provide for a given sector of the economy. Oregon’s decision to fund down to line 472 is an example. Given the multitude of other possible priorities, such as funding for first responders, housing, transportation, environmental protection and the like, what proportion should go to healthcare?

What are the advantages of Oregon’s approach to resource allocation? Let me list five:

  1. Priorities based on likely health outcomes. With limited resources and an ever-growing demand for healthcare services, it is crucial to develop strategies that ensure both efficient and equitable allocation decisions. By assessing the cost-worthiness of various interventions, the OHP seeks to ensure that limited resources are directed towards treatments that offer the greatest health benefits to the covered population.
  2. Evidence-based decisions. A cornerstone of the OHP is the commitment to evidence-based decision-making. Since the inception of the plan, the rankings of various treatments have changed significantly as new evidence has become available.
  3. Transparency of the process. OHP’s approach to setting priorities is open for all to see. This transparency encourages public engagement and facilitates the possibility of criticism that may point to needed changes.
  4. Focus on preventive care. Recognizing the long-term benefits of preventive care, the OHP places a strong emphasis on promoting early interventions aimed at reducing the burdens of preventable, chronic diseases.
  5. Focus on vulnerable populations. A noteworthy aspect of the OHP is its commitment to providing healthcare access to vulnerable groups, including low-income and uninsured individuals. By prioritizing equity and access, the OHP reduces health disparities and promotes a fairer distribution of healthcare resources.

Of course, such advantages do not mean that the OHP is above all criticism. Recently, it was noted, for example, that there is a critical shortage of residential care for persons in need of ongoing mental health or addiction treatment.[iii] However, what the OHP does offer is a distinctive experiment in setting healthcare priorities with the laudable goals of increasing efficiency, equity, and transparency.

Author Bio:


Gerald Winslow, PhD

Dr. Winslow is the Founding Director of the Institute for Health Policy and Leadership and the Research Professor of Religion and Ethics at Loma Linda University School of Religion. His research interests include biomedical ethics and the relationship of social ethics to health policy.


[i]Information about the Oregon Health Plan’s prioritized list is available at:

[ii] Section 1115 of the Social Security Act authorizes the Secretary of Health and Human Services to waive some of Medicaid’s requirements in order to approve pilot projects that are consonant with the goals of Medicaid so that states have flexibility to demonstrate possible improvements in coverage. The provisions for such waivers can be viewed here:

[iii]Ben Botkin, “Oregon Health Authority Report Flags Shortcomings in Medicaid System,” Oregon Capitol Chronicle, July, 31, 2023. Available at: