Defining and implementing medical necessity in Washington state and Oregon

Inquiry

Volumn 34, Issue 2, 1997, Pages 143-154

  Jacobson, Peter D ^a   Asch, Steven ^b   Glassman, Peter A ^b   Model, Karyn E ^b   Hernandez, John B ^b  

^a UNIVERSITY OF MICHIGAN SCHOOL OF PUBLIC HEALTH   (United States)

^b NONE

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; DECISION MAKING; HEALTH CARE MANAGEMENT; HEALTH CARE PLANNING; MEDICAL PRACTICE; QUALITATIVE DIAGNOSIS; TREATMENT PLANNING; UNITED STATES;

EID: 0030847052     PISSN: 00469580     EISSN: None     Source Type: Journal    
DOI: None     Document Type: Article

References (13)

1. Bergthold, L. A. 1995. Medical Necessity: Do We Need it? Health Affairs 14:180-190.
2. Eddy, D. M. 1996. Benefit Language: Criteria That Will Improve Quality While Reducing Costs. Journal of the American Medical Association 275:650-657.
3. Glassman, P. A., K. E. Model, J. P. Kahan, P. D. Jacobson, and J. W. Peabody. 1997. The Role of Medical Necessity and Cost-Effectiveness in Making Medical Decisions. Annuls of Internal Medicine 126:152-156.
4. Glassman, P. A., P. D. Jacobson, and S. A. Asch. 1997. Medical Necessity and Defined Coverage Benefits in the Oregon Health Plan. American Journal of Public Health (in press).
5. Hall, M. A., and G. F. Anderson. 1992. Health Insurers' Assessment of Medical Necessity. University of Pennsylvania Law Review 140:1637-1712.
6. Kahan, J. P., S. J. Bernstein, L. L. Leape, et al. 1994. Measuring the Necessity of Medical Procedures. Medical Care 32:357-365.
7. Kerr, E. A., B. S. Mittman, R. D. Hays, et al. 1995. Managed Care and Capitation in California: How Do Physicians at Financial Risk Control Their Own Utilization? Annals of Internal Medicine 123:500-504.
8. Lang, D. A. 1991. Medically Necessary Care is Not an Easy Concept to Define. LACMA Physician April 8: pp. 19, 21, 23.
9. Mariner, W. K. 1994. Patients' Rights After Health Care Reform: Who Decides What is Medically Necessary? American Journal of Public Health 84:1515-1520.
10. National Institute for Health Care Management (NIHCM). 1994. NIHCM - Benefits Language Proposal. Washington, D.C.
11. Peters, W. P., and M. C. Rogers. 1994. Variation in Approval by Insurance Companies of Coverage for Autologous Bone Marrow Transplantation for Breast Cancer. New England Journal of Medicine 330:473-477.
12. Russell, L. B., J. E. Siegel, N. Daniels, M. R. Gold, B. R. Luce, and J. S. Mandelblatt, 1996. Cost-Effectiveness Analysis as a Guide to Resource Allocation in Health: Roles and Limitations. In Cost-Effectiveness in Health and Medicine, M. R. Gold, L. B. Russell, J. E. Siegel, M. C. Weinstein, eds. New York: Oxford University Press.
13. U.S. General Accounting Office (GAO). 1994. Medicare Part B: Inconsistent Denial Rates for Medical Necessity Across Six Carriers. Statement of Eleanor Chelimsky, assistant comptroller general, before the Subcommittee on Regulation, Business Opportunities, and Technology, Committee on Small Business, House of Representatives, March 29. GAO/T-PEMD-94-7, Washington, D.C.