Defining 'medical necessity' in an age of personalised medicine: A view from Canada

Area of Science:

• Health Policy
• Genetics
• Healthcare Systems

Background:

• Medical necessity is crucial for healthcare funding decisions in Canada.
• Defining and implementing medical necessity presents significant challenges.
• Personalized medicine introduces new complexities to healthcare policy.

Purpose of the Study:

• To explore the challenges of defining medical necessity in the context of personalized medicine.
• To analyze the implications of genetically-informed medical necessity for healthcare policy and physician obligations.

Main Methods:

• Conceptual analysis of medical necessity in Canadian healthcare.
• Examination of the impact of personalized medicine on healthcare policy.
• Discussion of physician's legal and ethical roles in defining medical necessity.

Main Results:

• Medical necessity remains difficult to define and operationalize.
• Personalized medicine is expected to exacerbate these definitional challenges.
• Physicians will play a key role in defining genetically-informed medical necessity.

Conclusions:

• The integration of personalized medicine complicates the established concept of medical necessity.
• Physicians' obligations may limit the anticipated cost-saving benefits of personalized medicine.
• Clearer policy frameworks are needed to address genetically-informed medical necessity.