Charles C, Lomas J, Giacomini M
Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario.
Milbank Q. 1997;75(3):365-94. doi: 10.1111/1468-0009.00060.
Four meanings of medical necessity have emerged, evolved, and dominated past and current health policy debates about the appropriate level of service coverage under Canada's health insurance program. To explore the shift in definition, provincial government and national health care association position papers responding to federal legislative and policy reviews of Canada's health insurance program from 1957 to 1984 were examined, as were more current reports on medical necessity. Four meanings of medical necessity predominated: "what doctors and hospitals do"; "the maximum we can afford"; "what is scientifically justified"; and "what is consistently funded across all provinces." These meanings changed with time as different stakeholder associations and governments redefined the concept of medical necessity to achieve different policy objectives for health service coverage under Canada's health insurance program.
医疗必要性的四种含义已经出现、演变，并主导了过去和当前关于加拿大医疗保险计划下适当服务覆盖水平的卫生政策辩论。为探究定义的转变，我们研究了省级政府和全国医疗保健协会针对1957年至1984年加拿大医疗保险计划的联邦立法和政策审查所做出的立场文件，以及关于医疗必要性的最新报告。医疗必要性的四种含义占主导地位：“医生和医院所做之事”；“我们所能负担的最大限度”；“科学上合理之事”；以及“所有省份都持续资助之事”。随着不同利益相关者协会和政府重新定义医疗必要性的概念，以实现加拿大医疗保险计划下卫生服务覆盖的不同政策目标，这些含义随时间而变化。
