Mariner W K
School of Public Health, Boston University, MA 02118-2394.
Am J Public Health. 1994 Sep;84(9):1515-20. doi: 10.2105/ajph.84.9.1515.
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.
克林顿总统的《健康保障法案》赋予个人的并非无限制的医疗保健，而是一套明确规定的保险福利，其中包含特定的除外责任和限制条款。与几乎所有的改革提议一样，该法案将承保福利限制在医疗必需的服务上。如果医疗改革要控制成本，就无法涵盖所有医疗必需的护理。在缺乏普遍接受的医疗必要性定义的情况下，许多服务无法保证提供给所有患者，除非它们在联邦立法或法规中得到明确涵盖。如果没有联邦对医疗必要性的定义或列出承保服务的法规，医疗保险计划将保留决定其参保患者所需医疗服务的主要权力。
