Defining Medical Necessity under the Patient Protection and Affordable Care Act
Defining Medical Necessity under the Patient Protection and Affordable Care Act
复制标题
根据《患者保护和平价医疗法案》定义医疗必要性
DOI：
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发表时间：
2013
期刊：
影响因子：
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通讯作者：
Danielle Skinner
中科院分区：
文献类型：
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作者：
Danielle Skinner
尽管2010年的《患者保护与平价医疗法案》（Patient Protection and Affordable Care Act， ACA）承诺将医疗服务扩大到数百万美国人，但该法案将如何确定医疗必要性的含义——这一概念将继续作为规范医疗服务利用的关键手段——仍然是一个悬而未决的问题。ACA没有详细说明哪些是必要的，哪些不是必要的，而是责成美国卫生与公众服务部部长监督做出这些关键决定的过程。本文考虑了一系列关于ACA背景下医疗必要性决定的“元问题”。它通过研究一项试图平衡政府监管、医生自主权和推动管理式医疗的各种市场力量的法案所带来的政策挑战来做到这一点。其结果是对ACA规定的医疗必要性决定的内在政治性质的理解。
While the Patient Protection and Affordable Care Act (ACA) of 2010 promises to expand care to millions of Americans, how the bill will determine the meaning of medical necessity—the concept that continues to serve as the key means for regulating the utilization of health care services—remains an open question. Instead of detailing what is and is not considered medically necessary, the ACA charges the U.S. Secretary of Health and Human Services with overseeing the processes by which these critical determinations will be made. This article considers a series of “meta-questions” regarding the place of medical necessity determinations within the context of the ACA. It does so by examining the policy challenges presented by a bill that attempts to balance government regulation, physician autonomy, and the various market forces driving managed care. The result is an understanding of the inherently political nature of medical necessity determinations under the ACA.
影响因子：
3.5
作者：
Case, P;Austin, SB;Spiegelman, D
通讯作者：
Spiegelman, D