Fairness and rationing implications of medical necessity decisions

American Journal of Managed Care

Volumn 5, Issue 12, 1999, Pages 1525-1531

  Rosenblatt, Laurie ^a   Harwitz, Daniel G ^b  

^a BRIGHAM AND WOMEN S HOSPITAL   (United States)

^b DEPARTMENT OF COLORECTAL SURGERY   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

HEALTH CARE; HEALTH MAINTENANCE ORGANIZATION; MEDICAL DECISION MAKING; PATIENT; PHYSICIAN; PRIORITY JOURNAL; RESPONSIBILITY; REVIEW;

HEALTH CARE AND PUBLIC HEALTH;

DECISION MAKING; ETHICS, MEDICAL; FEMALE; HEALTH CARE RATIONING; HEALTH MAINTENANCE ORGANIZATIONS; HUMANS; INSURANCE COVERAGE; MALE; NEEDS ASSESSMENT; UNITED STATES; UNNECESSARY PROCEDURES; UTILIZATION REVIEW;

EID: 0033405052     PISSN: 10880224     EISSN: None     Source Type: Journal    
DOI: None     Document Type: Review

References (26)

1. Rosner F. The ethics of managed care. Mt Sinai J Med 1997;64:8-19.
2. Thomasma DC. The ethics of managed care: Challenges to the principles of relationship-centered care. J Allied Health Summer 1996:233-246.
3. Warner EG. Ethics and morality vs managed care. Ohio State Med Assoc 1996;89:275-279.
4. Bell H. Managed care ethics: A delicate balance. Minn Med 1996;79:11-16.
5. Jeffrey N. Aetna to set national review plan for HMO subscribers denied coverage. Wall Street Journal. January 12, 1999:B6.
6. Aaron HJ. Questioning the cost of biomedical research. Health Aff 1986;5(2):96-99.
7. Hansson LF, Norheim OF, Ruyter KW. Equality, explicitness, severity, and rigidity: The Oregon plan evaluated from a Scandinavian perspective. J Med Philos 1994;19:343-366.
8. Hall MA. The problems with rule-based rationing. J Med Philos 1994;19:315-332.
9. Ambulatory care guidelines. In: Doyle RL, Feren AP, Jacobs RJ. Healthcare Management Guidelines. November 1996 ed. Seattle, WA: Milliman & Robertson Inc; 1996;3:2-34.
10. Plows CW. Response to comments on the AMA report, ethical issues in managed care. J Clin Ethics 1995;6:318-319.
11. Sabin JE. Caring about patients and caring about money: The American Psychiatric Association code of ethics meets managed care. Behav Sci Law 1994;12:317-330.
12. Howe EG. Inner turmoil: An important consideration in conflicts of interest. J Clin Ethics 1995;6:367-371.
13. Levinsky N. The doctor's master. N Engl J Med 1984;311:1573-1574.
14. Churchill LR. Damaged humanity: The call for a patient-centered medical ethic in the managed care era. Theor Med Bioeth 1997;18:113-126.
15. Morreim EH. Gaming the system: Dodging the rules, ruling the dodgers. Arch Intern Med 1991;151:443-447.
16. Mechanic D. Rationing of medical care and the preservation of clinical judgment. J Fam Pract 1980;11:431-433.
17. Sabin JE, Forrow L, Daniels N. Clarifying the concept of medical necessity. Med Interface December 1991:35-42.
18. Nord E, Erik, Richardson J, Street A, Kuhse H, Singer P. Maximizing health benefits vs egalitarianism: An Australian survey of health issues. Soc Sci Med 1995;41:1429-1437.
19. Daniels N. Meeting the challenges of justice and rationing: Four unsolved rationing problems: A challenge. Hastings Cent Rep 1994;24:27-29.
20. Rawls J. A Theory of Justice. Cambridge, MA: Harvard University Press; 1971.
21. Goold SD. Allocating health care: Cost-utility analysis, informed democratic decision-making, or the veil of ignorance? J Health Polit Policy Law 1996;21:69-98.
22. Fleck LM. A democratic decision-making approach. University P Law Rev 1992;140:1579-1638.
23. Miles SH, Koepp R. Comments on the AMA report ethical issues in managed care. J Clin Ethics 1995;6:306-311.
24. Daniels N, Sabin JE. Last chance therapies and managed care: Pluralism, fair procedures, and legitimacy. Hastings Cent Rep 1998;28:27-41.
25. Benjamin M, Cohen C, Gruchowski E. What transplantation can teach us about health care reform. N Engl J Med 1994;330:858-860.
26. Braithwaite SS. Distributive justice: Must we say yes when society says no? In: Monagle JF, Thomasma DC, eds. Healthcare Ethics: Critical Issues. Gaithersburg, MD: Aspen Publishers; 1994:295-304.