Date of Award
Spring 6-2026
Document Type
Thesis
Degree Name
Bachelor of Science (B.S.) in Public Health Studies: Pre-clinical Health Science and University Honors
Language
English
Subjects
Universal Health Care, GLP-1 Receptor Agonists, Single-Payer, Cost Containment, Taiwan National Health Insurance, Health Policy and Economics, Metabolic Syndrome
Abstract
In 2022, Oregon voters passed Measure 111, constitutionally mandating access to affordable health care. As the Universal Health Plan Governance Board (UHPGB) designs the state’s proposed single-payer system, it faces an unprecedented financial vulnerability: the clinical demand for GLP-1 receptor agonists. These high-cost, indefinite-use medications for obesity and metabolic syndrome threaten to overwhelm fixed public budgets. Historically, both the Oregon Health Plan’s Medicaid framework and commercial private insurers have relied on static cost-containment models—categorical exclusions, step therapy, and aggressive utilization management—that achieve short-term fiscal solvency at the expense of comprehensive preventative care. This thesis argues that to fulfill the mandate of universal care, Oregon must abandon these exclusionary tactics and adopt dynamic macroeconomic cost-containment strategies modeled after Taiwan’s National Health Insurance (NHI).
Specifically, this paper proposes the integration of Taiwan’s Drug Expenditure Target (DET) and centralized negotiation mechanisms into Oregon’s single-payer framework. By implementing a post-hoc reimbursement reconciliation system, the state can shift financial risk upstream to pharmaceutical manufacturers rather than downstream to patients. Furthermore, while acknowledging the evolutionary environmental drivers of metabolic syndrome and the clinical reality of post-cessation weight regain, this framework positions GLP-1s as a vital pharmacological bridge rather than an indefinite cure. By pairing dynamic global budgeting with targeted investments in community-based preventative infrastructure and aggressive de-stigmatization of obesity treatment, Oregon can secure both patient access and systemic solvency, establishing a viable structural precedent for universal health care in the United States.
Recommended Citation
Rajesh, Manoj and Tuepker, Anaïs, "Moving Beyond Traditional Cost Containment for GLP-1 Coverage within Oregon's Proposed Universal Health Plan" (2026). University Honors Theses. Paper 1903.