Patients' Rights After Health Care Reform: Who Decides What Is Medically Necessary?
Mariner, Wendy K.
American Journal of Public Health. 1994 Sep; 84(9): 1515-1520.
President Clinton's Health Security Act entitles individuals not to unlimited health care, but to a package of defined insurance benefits with specific exclusions and limitations. Like virtually all reform proposals, it would limit covered benefits to services that are medically necessary. If health reform is to control costs, not all medically necessary care can be covered. In the absence of a generally accepted definition of medical necessity, many services will not be guaranteed to all patients unless they are explicitly covered in the federal legislation or regulations. Without a federal definition of medical necessity or regulations listing covered services, health insurance plans will retain the primary authority to decide what is medically necessary for their patient subscribers.
Bone Marrow; Breast Cancer; Cancer; Decision Making; Economics; Government; Government Financing; Government Regulation; Health; Health Care; Health Care Reform; Health Insurance; Health Maintenance Organizations; Incentives; Insurance; Legal Rights; Legislation; Mandatory Programs; Organizations; Patients; Patients' Rights; Public Policy; Regulation; Research; Rights; Standards; State Government; Therapeutic Research; Tissue Transplantation; Transplantation;
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Mariner, Wendy K. (1994-08)Like most reform proposals, President Clinton's proposed Health Security Act offers universal access to care but does not significantly alter the nature of patients' legal rights to services. The act would create a system ...