Chodoff P
George Washington University, Washington, DC, USA.
Psychiatr Serv. 1998 Nov;49(11):1481-3. doi: 10.1176/ps.49.11.1481.
Managed care and, specifically, the need to conform to medical necessity requirements have had a dramatic effect on medical and psychiatric practice, especially on psychotherapy. The author describes the progression of the concept of medical necessity from a simple accounting of services reimbursable by insurance companies to an ambiguous term without definitional consensus. He describes its relationship to the medical model and discusses the incongruity between medical necessity and certain aspects of psychotherapy. He proposes a broader concept--health necessity--based on an evaluation on the merits of the advantages, disadvantages, and costs of medical and psychiatric services.
管理式医疗，尤其是符合医疗必要性要求的必要性，对医学和精神病学实践产生了巨大影响，特别是对心理治疗。作者描述了医疗必要性概念的发展历程，从保险公司可报销服务的简单核算，到一个没有定义共识的模糊术语。他描述了其与医学模式的关系，并讨论了医疗必要性与心理治疗某些方面之间的不一致。他基于对医疗和精神科服务的优缺点及成本的评估，提出了一个更广泛的概念——健康必要性。
