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Treatment Foster Care Oregon (TFCO) is an alternative to congregate care, for youth involved in the juvenile justice and/or child welfare systems. Though demonstrated as clinically--and cost-effective across multiple rigorous trials, the long-term cost benefit of TFCO has not been considered. This study follows n = 166 females from adolescence to young adulthood, who were involved in both systems and referred for out-of-home-care. Records of arrest, court, incarceration (juvenile, jail, and prison), monitoring (parole and probation) and child-welfare services were included in a long-term cost-benefit analysis. Outcomes highlight ongoing benefit of the TFCO intervention, nearly 10 years post-intervention., Female adolescents represent approximately 30% of the juvenile justice population (Ehrmann, Hyland, & Puzzanchera, 2019). For youth involved in the juvenile justice system (JJS) with repeated offenses and severe problem [...]

ON 3 NOVEMBER 1964 more than 60 percent of voters in Oregon chose to repeal the state's death penalty. (1) Only the second time in American history that abolition had [...]

DURING A LUNCHTIME SESSION, on Tuesday, November 17, 2016, Daniel J. Tichenor of the University of Oregon Wayne Morse Center for Law and Politics moderated a panel discussion about immigration [...]

Purpose: The study describes Oregon state policy and supply developments for licensed long-term-care settings, particularly apartment-style assisted living facilities and more traditional residential care facilities. Design and Methods: Data came from a variety of sources, including state agency administrative records, other secondary data sources, and key informant interviews. Descriptive statistics examined public financing, Medicaid reimbursement, and licensed bed supply trends from 1986 to 2004, as well as Medicaid resident use between 1990 and 2004. Results: Residential care expansion, combined with nursing facility contraction, has transformed Oregon's supply of licensed long-term-care settings in favor of less institutional options. State financing, reimbursement, and licensing policies varied across provider type, with greater public resources supporting growth of assisted living facilities. By 2004, such settings were more likely to be Medicaid providers than residential care facilities and had a higher proportion of Medicaid residents relative to available bed supply. Implications: State financing and reimbursement policies may play a role in stimulating the supply of apartment-style assisted living available to low-income and/or rural service users. Less favorable policy conditions may have unintended consequences for the supply and use of other residential care settings. Key Words: Medicaid, Home- and community-based services, Waivers, Long-term care, Adult foster care, Nursing homes

New Jersey and Oregon maintain bans on self-service gasoline stations because full-service gasoline stations generate jobs, are appropriate for disabled customers, and guarantee safety of environment and users. The effect of the bans on gasoline prices is discussed.

The approval of a Health Care Financing Administration (now called Centers for Medicare and Medicaid Services) 1115 Medicaid waiver in Oregon allowed the state to design and implement an expanded publicly funded health care system, the Oregon Health Plan (OHP). Integral to OHP is the administration of physical and behavioral health services, including outpatient substance abuse treatment, through contracted managed care organizations. The two overarching changes to the outpatient substance abuse treatment system were expanded Medicaid eligibility and new operating procedures for the outpatient substance abuse treatment system. The authors used grounded theory to examine the effects of this transition on the treatment system, with an emphasis on the experiences of treatment providers. Key words: managed care Medicaid qualitative research substance abuse treatment universal health care, In 1993 Oregon became one of the first states to apply for and receive a Health Care Financing Administration (HCFA; now called Centers for Medicare and Medicaid Services) 1115 Medicaid [...]

It's rare for a state agency director to confess before legislative committees that his organization is falling short. But the director of the Oregon Department of Human Services (DHS) did [...]

In this article I examine how the neoliberal agenda of downsizing the state and minimizing its role in regulating the market has shaped welfare policy and the work of welfare provision. Using a study of welfare reform in Oregon, I explore how the enactment of welfare-to-work policies positions workers to negotiate the ideological terrain of welfare reform and the conflicts that privatization and devolution generate in a social welfare context. Self-sufficiency, the professed goal of welfare-to-work programs, is a complex concept, saturated with ideological meaning. Examination of the work of welfare provision provides an opportunity to analyze how workers give meaning to self-sufficiency and construct their work as positive for the families they serve. However, high caseloads, unrealistic agency expectations, and conflicting mandates bear down hard on workers, creating disenchantment with agency policy and undermining workers' ability to meet clients' needs. [welfare, ideology, work, the United States, neoliberalism]

This article discusses the collaboration effort among various antagonistic groups in Oregon's Snake River region to recover the endangered chinook salmon. The author asserts that the Nez Perce Tribe, local government, landowners, and landusers who historically contested over boundaries, space and efforts to control people therein were able to collaborate over this environmental issue, revealing how conflict can be resolved into cooperation over shared ideology which can also shift definitions of identity, space and place.

The Oregon 1994 Death With Dignity Act prescribes an evaluation by a psychologist or psychiatrist when the patient is suspected to be suffering from impaired judgment. Several attempts have been made to propose procedures for assessing end-of-life mental conditions and competence. The psychologist's role may include ethical considerations, protecting patients' rights to autonomy, ensuring competent judgment, preventing unnecessary suffering and inappropriate diagnoses of mental disorders, and supporting family members and the health care team.

End of life decisions and hastened suicide are discussed following the passage of the Death With Dignity Act in Oregon in 1994. Case examples are presented including a vignette highlighting ethical issues. Arguments for and against suicide prevention are presented, and the pros and cons of rational suicide are detailed. The experience with physician-assisted suicide in the Netherlands is briefly presented, and it is noted that in rare cases physician-assisted suicide is permitted for individuals in the Netherlands suffering primarily from mental disorders. The role of the mental health professional in end of life decisions is discussed along with a description of the proposed work of the recently established American Psychological Association working group on assisted suicide and end of life decisions.

The experience encountered by Oregon when it began testing student ability in social studies shows that standardized tests do not result in the effective teaching of the subject. Teachers were dismayed to find out that the tests were multiple-choice questions on World War I, Constitutional amendments and other unrelated facts. Teachers were concerned that they might have to turn their classrooms into information factories before their students can earn Oregon's 10th grade Certificate of Initial Mastery. The tests were also counterproductive in fostering multicultural education which attempts to explain the world as it is and not just to memorize facts.

Oregon's reliance on managed care to provide health care for its poor residents may serve as a lesson to other states. The Oregon Health Plan passed in 1989 enrolled many formerly uninsured residents in managed care plans. As Medicaid patients are enrolled in managed care, the managed care plans try to enroll the healthiest patients. This leaves city and county public hospitals to care for the sickest patients. Community health centers are also receiving smaller Medicaid reimbursements. When Oregon began charging enrollees premiums, many residents dropped out of the program.

The Oregon Health Plan has succeeded in formulating a benefits package for all Medicaid recipients that is more precise than the plans of most insurance companies. In 1989, a commission mandated by the law which was passed that year ranked more than 700 diagnoses and treatments and decided not to cover any below line 587. The plan was approved by the Clinton administration in 1993 and implemented in 1994. All Oregon residents with incomes under the poverty level were enrolled in Medicaid, adding 100,000 uninsured people to the rolls. Most are in a managed care plan. The plan has been fairly well accepted by physicians and 88% of the patients are satisfied with the plan.

The state of Oregon decided to cover all potentially eligible Medicaid citizens to 100% of poverty. Previously, Oregon had covered persons up to 67% of poverty. In order to keep overall program costs in check, Oregon decided to limit the number of services that its Medicaid program would cover. Oregon's normative choice was to contain program costs by covering all eligible persons up to 100% of poverty, while at the same time uniformly limiting access to certain services for everyone in the overall group of eligible persons. The state developed a prioritization list of medical services and priced the components on the list. The amount of money ultimately available for the Medicaid program was a political decision informed by data about the cost of different services and influenced by the priorities set through an independent process of priority-setting. Physicians were asked to determine what works medically, how well it works, and what benefits accrue to patients. Recognizing that physician perspectives on efficacy might vary from patients' perspectives on valuation of benefits, Oregon's planners developed a method for valuing medical outcomes that stemmed from particular medical interventions. This blend of medical fact and value to patients allowed for comparing valuations by introducing cost considerations. Condition-treatment (CT) pairs linked a medical condition with one or more courses of treatment. The goal was to determine the likely incremental medical benefit from a given treatment. In addition, Oregon developed a Quality-of-Well-Being scale to determine the net patient benefit from medical intervention and used a telephone survey to value that net benefit. A cost-benefit ratio was derived, and a prioritization of CT pairs was developed. The article analyzes and evaluates Oregon's use of cost-benefit calculations in the allocation of Medicaid funds, noting that Oregon itself backed away from many of the implications of its cost-benefit analysis and that the Americans with Disabilities Act has constrained use of quality-of-life judgments in Medicaid resource allocation decision-making. Key words - cost-benefit, Oregon, Medicaid, disabilities, rationing, resource allocation

The innovative Oregon Health Plan (OHP) was introduced in 1994 to enable the state to provide health care coverage to as many uninsured Oregonians as possible. The program is considered to be a success. Oregon's number of uninsured citizens has fallen from 18% to 11%, charity care in hospitals has dropped by 30% while the hospitals' bad debt has declined by 11%. Patient satisfaction has also improved. However, the OHP also has a downside. Physicians have been complaining about low payments and difficult patients., Three years after its debut, doctors in the trenches give the state popular health plan mixed reviews. Although initially criticized for its use of rationing, the Oregon Health Plan - [...]

Oregon Gov John Kitzhaber believes that the Oregon Health Plan (OHP) that he helped design works. The program rations medical care to the poor by prioritizing diagnosis/treatment cares based on their medical effectiveness and value to society. Kitzhaber claims that OHP has helped reduce the number of uninsured Oregonians from 18% to 11% and uninsured children from 21% to just 8%. However, while some doctors are thriving under the new program, the governor acknowledges that other physicians have legitimate reasons to complain about reimbursement rates., So says John Kitzhaber, a former emergency physician who helped design the program and is now Oregon's governor. Nevertheless, he concedes many physicians have "legitimate concerns" about reimbursement. You wouldn't [...]

The State of Oregon has proposed a new method of financing health care services for its citizens. Oregon proposes to fund only the most cost-effective services. But in addition to narrowing the offering of health services funded by the State, Oregon proposes to fund all of the State's poor for services, no matter the family status. This broadened number of poor (everyone at the federal poverty level and below, single or married, children or not) will provide health care for more than 200,000 additional Oregonians. The supplementary legislation, SB 534 and SB 935, combined with broadened health care coverage for the poor (SB 27) will cover an additional 478,000 Oregonians. Nearly 95 % of its citizens will have some form of health insurance in Oregon.

The state medical society and 11 managed-care organizations in Oregon have collaborated to form the Ambulatory Records Certification (ARC) program. Under the ARC program, doctors in the state will only have to undergo one audit every two years. This approach saves money for the health plans and doctors are spared of multiple audits. The Oregon Medical Association, which handles the program, gets 8% of revenues as profit., Duplicate audits by multiple plans - few things are more annoying and less profitable. This state has devised a solution that could work everywhere. It's one of the biggest headaches [...]

Oregon is implementing long-term education reform, keeping in mind the complex new world and the expanding global market. Technology is changing at a fast pace and it is affecting peoples' lifes as never before. Students need adequate training and understanding of the work environment to cope with emerging trends. Oregon aims to provide the necessary help to these students by appropriately revamping curricula with the cooperation of educators, teachers, parents and community members. The implementation and methods of the program are discussed.

The Oregon Health Plan implemented in Feb. 1994 has met with resounding success. The plan involves denying payment for certain medical services to provide increased medical coverage to state residents. The program has reduced emergency room use and charity care, increased the number of insured patients and improved the reimbursement of doctors., Jean I. Thorne, Oregon's director of medical assistance programs, likes to tell the story of a reporter from a large east coast newspaper who came calling shortly after Oregon began [...]

The Medicaid health plan implemented in Oregon in 1994 is based on a list of conditions and treatments. Healthcare coverage is provided to all citizens below the federal poverty limit. The health plan also extends medical aid to all HIV infected Oregon citizens. The decision to provide aid even during the last stages of HIV will benefit many people. However since federal aid is limited and HIV treatment is expensive the implementation costs will be greater. Lists prepared by the health-service commission since 1991 are discussed.

This article is an attempt to evaluate the Oregon plan from the perspective of a Scandinavian national health care system. The Nordic welfare states are marked by a strong emphasis on equality. As an example of an egalitarian system we present the Norwegian health care model in part one. In part two, the arguments in favor of a one tier system in Norway are presented and compared to Oregon's two tier system. Although we argue, in part three, that a comparison of the degree of explicitness in the prioritization process shows that Norway has much to learn from Oregon, we do believe that the Norwegian system has some attractive elements that may function as an important corrective. In part four we present the Norwegian Guidelines for priority-setting and discuss the weight assigned to the severity of disease criterion. It is argued that the exclusion of information about the severity of disease partly explains the counterintuitive ranking of treatment-condition pairs in Oregon's initial method based on the principle of health maximization. A normative analysis of the conflicting norms of efficiency and equality of results is called for. The final part of the paper is devoted to the problem of rigidity. Henry J. Aaron has argued that the Oregon system is insensitive to inter-individual variations within each diagnosis-treatment pair. This objection is a severe one, since the system might end up treating patients unfairly on the individual level. To overcome this problem, we suggest a selection rule that should be more capable of dealing with the problem of rigidity. Key Words: equality, fairness, one tier system, prioritization, severity of disease, rigidity

This essay argues that our national efforts at health reform ought to be informed by eleven key lessons from Oregon. Specifically, we must learn that the need for health care rationing is inescapable, that any rationing process must be public and visible, and that fair rationing protocols must be self-imposed through a process of rational democratic deliberation. Part I of this essay notes that rationing is a ubiquitous feature of our health care system at present, but it is mostly hidden rationing, which is presumptively unjust. Part II argues that the need for health care rationing is inescapable. Although Oregon is flawed as a model of health rationing, it gives us worthy moral lessons for health reform at the national level, which I analyze and defend in Part III. The most significant of these lessons is the importance of rational democratic deliberation in articulating fair rationing protocols for a community. In Part IV I sketch the philosophic justification for this approach and respond to some important criticisms from Daniels. Key Words: cost containment, democratic deliberation, fairness, justice, rationing

The Oregon Health Plan gained national attention by changing the focus of health care from who is covered to what is covered. This change was facilitated by insurance reforms in the areas of small market, employer mandates, high risk pooling and Medicaid. Most controversial of the reforms is the use by the legislature of a prioritized list of health services to determine benefit levels for the insurance programs. Significant debate has occurred over whether the use of such a list is rationing or reasoning. The Oregon Health Plan represents a thoughtful and deliberate blending of fact with public value for the purpose of responsible health policy. It is that unique blending of public values developed through community participation with fact that focused the attention of the world on Oregon. Key Words: community participation, employer mandates, health care reform, prioritization, rationing, small market insurance reform