It wasn't long until a child diagnosed with leukemia was denied care because the services weren't viewed as cost-effective in Medicaid's new system.  The uproar over denial of care for cancer treatments eventually led to Oregon abandoning the system altogether. That being said, efficiency and equity are not in direct opposition, per se.  One of the most attractive elements of efficiency is that it should in theory free up funding that can be devoted to providing services for the poor.