Medical Necessity in the Contexts of Patient Care, Health Politics, and Setting Limits to Health Services. An Analysis in Medical Philosphy, Health Ethics, and Social Law.

患者护理、卫生政治和卫生服务限制背景下的医疗必要性。

• 批准号: 319849847
• 负责人: Professor Dr. Stefan Huster
• 金额: --
• 依托单位: Lehrstuhl ÖR, Sozial- und Gesundheitsrecht und Rechtsphilosophie
• 依托单位国家: 德国
• 项目类别: Research Grants
• 财政年份: 2016
• 资助国家: 德国
• 起止时间: 2015-12-31 至 2019-12-31
• 项目状态: 已结题
• 来源: https://gepris.dfg.de/gepris/projekt/319849847?language=en
• 关键词: Medical; Necessity; Contexts; Patient; Care

The concept of "medical necessity" (med-n) is playing a central role in discussions and norm-setting regarding (a) appropriate patient care, (b) fair allocation of medical resources, and (c) social law's regulations of patients' claims against Statutory Health Insurance. Cum grano salis it can be stated that in these three contexts med-n has the function of a regulatory idea, much the same as th concept of "medial indication". In a nutshell, med-n is marking the realm of health care services that patients can legitimately claim according to medical, ethical, and socio-legal reasoning. On first sight, med-n appears as an objective medical terminus technicus. In the light of these findings it is notable, that the notion of med-n is notoriously vague and open for different interpretations. As a result its aptitude as a regulatory concept might be doubted. In particular, the notion of med-n seems to be used and understood differently in different contexts. It merges normative and descriptive elements in a not yet systematically understood manner and it remains obscure with regard to type und genesis of implicit value judgements. This project wants to remediate these deficits. It should help answering the following central questions: - outlining the different uses of the med-n-concept- the interaction of descriptive and normative elements of the concept- The plausibility of a consistent ideal concept of med-n- the pragmatic and normative advantages and dangers of med-n as regulatory concept. With the expected answers we hope to mark contours of the substantive normative disagreements over professionalism, autonomy, and paternalism in patient care. Moreover, we expect greater transparency for debates in politics and ethical about appropriate access to care. Also, it might lead to greater clarity about consistency and background assumptions of legal requirements for the scope of our (publically financed) Statutory Health Insurance. Whether the regulatory med-n-concept is to be specified, intercontextually unified or altogether given up in favor of "fresh" or more precise concepts can only be answered at the end of the project.

“医疗必要性”的概念在讨论和规范制定方面发挥着核心作用，涉及（a）适当的病人护理，（B）公平分配医疗资源，和（c）社会法对病人向国家健康保险索赔的规定。可以说，在这三种情况下，med-n具有调节观念的功能，与“中介指示”的概念大致相同。简而言之，med-n标志着患者可以根据医学、伦理和社会法律推理合法要求的医疗保健服务领域。乍一看，med-n似乎是一个客观的医疗技术终端。根据这些发现，值得注意的是，med-n的概念是众所周知的模糊和开放的不同解释。因此，它作为一个管理概念的能力可能会受到怀疑。特别是，med-n的概念似乎在不同的上下文中被不同地使用和理解。它以一种尚未系统理解的方式融合了规范性和描述性元素，并且在隐性价值判断的类型和起源方面仍然模糊不清。本项目旨在弥补这些缺陷。它应该有助于回答以下中心问题：-概述不同用途的med-n概念的相互作用的描述性和规范性元素的概念的一致的理想概念med-n的可接受性的实用和规范的优势和危险的med-n作为监管概念。通过这些预期的答案，我们希望能够勾勒出病人护理中关于专业性、自主性和家长式作风的实质性规范性分歧的轮廓。此外，我们期望在政治和道德上关于适当获得护理的辩论有更大的透明度。此外，它可能会导致更清晰的一致性和背景假设的法律的要求的范围内，我们的（财政资助）法定健康保险。是否规范的med-n-概念是被指定的，相互关联的统一或完全放弃，以支持“新鲜”或更精确的概念，只能在项目结束时回答。

项目成果

„Medizinische Notwendigkeit“: Herausforderungen eines unscharfen Begriffs

“医疗必要性”：模糊术语的挑战

• DOI: 10.1007/s00481-018-0497-5
• 发表时间: 2018
• 期刊: Ethik in der Medizin
• 影响因子: 0.6
• 作者: Schöne-Seifert;Bettina;Daniel R. Friedrich;Anke Harney;Stefan Huster;Heiner Raspe
• 通讯作者: Heiner Raspe

[Medical Methods: What Makes them Necessary? Part I: Medical Methods, medical Necessity and its Main Criteria].

[医疗方法：什么使它们必要？

• DOI: 10.1055/a-0965-6866
• 发表时间: 2019
• 期刊: Gesundheitswesen (Bundesverband der Arzte des Offentlichen Gesundheitsdienstes (Germany))
• 作者: Heiner;Daniel R. Friedrich;Anke Harney;Stefan Huster;Bettina Schoene-Seifert
• 通讯作者: Bettina Schoene-Seifert

[Medical Methods: What Makes them Medically Necessary? Part II: Further Criteria, Overuse, Moving Thresholds, and Grey Zones].

[医疗方法：什么使它们具有医疗必要性？

• DOI: 10.1055/a-0965-6748
• 发表时间: 2019
• 期刊: Gesundheitswesen (Bundesverband der Arzte des Offentlichen Gesundheitsdienstes (Germany))
• 作者: Heiner;Daniel R. Friedrich;Anke Harney;Stefan Huster;Bettina Schoene-Seifert
• 通讯作者: Bettina Schoene-Seifert