Setting Health Care Priorities in Oregon-Reply

In Reply. —I thank Drs Gillette and MacLean for their comments. Neither the Oregon process nor the proposed necessary-care guideline approach excludes costs as a factor to be considered in setting priorities. Cost is the meta-factor, the very raison d'etre , for both processes. If resources were not limited, there would be no need to set priorities in the first place. Moreover, although the ultimate goal in Oregon is to expand access to necessary care, this elusive goal will not be reached unless and until costs are controlled. Any method for setting health care priorities will succeed in constraining costs, provided that sufficient numbers of low-priority services are identified and removed from coverage under insurance plans. The point of my article is that attempting to identify these low-priority services using cost-effectiveness formulas, or by asking average people how much they would be willing to pay for specified services, will almost certainly