Appropriate and necessary healthcare: new language for a new era.
Conceptual and language changes are necessary to accompany the paradigm shift from fee-for-service medicine to managed care. Medical necessity is an inadequate and ambiguous term defined differently by providers, payers, patients, and legislators. The attempt by legislators in Minnesota to develop a universal standard benefits set for healthcare services strikingly underscores the need to define relevant terminology to accompany the transition to managed care. We suggest the term appropriate and necessary healthcare as a state-of-the-art term for the new era of managed care.
Oberg
C N
CN
Hennepin Faculty Associates, Minneapolis, MN 55404, USA.
Bosse
L L
LL
Mosow
S R
SR
Bach
M L
ML
D014487:Centers for Medicare and Medicaid Services, U.S.; D004991:Ethics, Institutional; D018588:Fee-for-Service Plans; D015276:Health Care Rationing / Q000145:classification* / Q000191:economics; D006301:Health Services Needs and Demand / Q000145:classification* / Q000191:economics; D008329:Managed Care Programs / Q000191:economics / Q000331:legislation & jurisprudence / Q000592:standards* / Q000706:statistics & numerical data; D008910:Minnesota; D011787:Quality of Health Care / Q000145:classification / Q000592:standards; D012945:Social Values; D009626:Terminology as Topic; D014481:United States