Medical technology assessment and practice guidelines: their day in court.
There is the expectation that outcomes research and the promulgation of medical practice guidelines will be able to identify and hopefully reduce the amount of unnecessary or inappropriate medical care through a variety of methods, including utilization review. However, past efforts by public and private insurers to deny claims on the basis of formal technology assessments or practice guidelines have frequently been overturned by the courts for multifarious reasons. This paper examines the court's reluctance to accept a variety of technology assessment methods in coverage policy decisions. The paper reviews the options that have been proposed to restrict judicial involvement in the formulation of coverage policy and then proposes a new option that employs a more precise taxonomy of medical practice assessment.
Anderson
G F
GF
School of Hygiene and Public Health, Johns Hopkins University, Baltimore, MD.
Hall
M A
MA
Steinberg
E P
EP
D000529:Complementary Therapies; D032982:Contracts; D003365:Costs and Cost Analysis; D035082:Federal Government; D033161:Government Regulation; D006801:Humans; D007348:Insurance, Health / Q000191:economics / Q000331:legislation & jurisprudence* / Q000592:standards; D033222:Judicial Role; D016134:Organizational Policy; D017063:Outcome Assessment, Health Care / Q000331:legislation & jurisprudence / Q000592:standards; D017410:Practice Guidelines as Topic; D013673:Technology Assessment, Biomedical / Q000191:economics / Q000331:legislation & jurisprudence* / Q000592:standards; D036302:Therapeutic Human Experimentation; D014481:United States