Determining "Medical Necessity" in Mental Health Practice

Dados Bibliográficos

ID20334572
AutoresJames E Sabin (Harvard University), Norman Daniels (Tufts University)
Ano1994
Volume24
Fascículo6
Páginas5
Data de publicação1994-11-01
Peer ReviewedSim
Open AccessNão
TipoARTICLE
PeriódicoThe Hastings Center Report (JOURNAL)
Identificadores do periódicoISSN: 0093-0334 • E-ISSN: 1552-146X
EditoraJSTOR (PUBLISHER)
DOI10.2307/3563458
PMID7860291
OpenAlexW2069579918
IdiomaEN
Citações recebidas12
Referências citadas2

In previous work on home care and in vitro fertilization we have\nshown that determinations of medical necessity often rest on a range of moral\nconsiderations as well as clinical facts. This paper reports the results of a\nstudy of difficult insurance coverage decisions brought to us by mental health\nclinicians and reviewers in a managed care setting. We explored these cases\nwith the involved personnel by applying elements of the Socratic approach --\neliciting the clinician's (or reviewer's) considered views, varying crucial\ncomponents of the case, and examining the effects on their reasoning about\nmedical necessity. This process revealed a recurrent conflict between what we\ncall "hardline" and "expansive" views of medical necessity. Although this\nconflict often surfaces as disagreement about medical facts and diagnosis, we\nbelieve that it frequently reflects unrecognized moral disagreement about the\ntargets of clinical intervention and the ultimate goals of psychiatric\ntreatment. In six case studies we examine the reasoning behind the\ndeterminations of medical necessity. In the discussion we present three models\nfor defining medical necessity that can be discerned in the clinical\nreasoning, and propose what we regard as a defensible rationale for how the\nconcept of medical necessity can be used in the administration of health\ninsurance benefits

Anxiety · Cover (algebra) · Family medicine · Medical practice · Mental health · Psychiatry · Shyness · Engineering · Medicine · Mental Health and Psychiatry · Psychology · Psychotherapy Techniques and Applications · Transactional Analysis in Psychotherapy

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