Oberg C N, Bosse L L, Mosow S R, Bach M L
Hennepin Faculty Associates, Minneapolis, MN 55404, USA.
Am J Manag Care. 1997 Mar;3(3):423-8.
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.
观念和语言的转变对于从按服务收费医疗模式向管理式医疗的范式转变而言是必要的。医疗必要性是一个不充分且含混不清的术语,不同的医疗服务提供者、支付方、患者和立法者对其有不同的定义。明尼苏达州的立法者试图为医疗服务制定一套通用的标准福利套餐,这突出表明了在向管理式医疗过渡过程中定义相关术语的必要性。我们建议使用“适当且必要的医疗保健”这一术语,作为管理式医疗新时代的一个先进术语。