[Medical Necessity: A Notoriously Fuzzy and Therefore Dispensable Concept?]

Area of Science:

• Health Policy
• Medical Ethics
• Health Systems Research

Background:

• The concept of medical necessity (medN) lacks a precise definition, despite its crucial role in healthcare decision-making.
• Current applications of medN are often dichotomous, lacking nuanced understanding.
• Existing definitions fail to capture the dynamic and procedural nature of determining medical necessity.

Purpose of the Study:

• To propose a redefinition of medical necessity (medN) as a dynamic outcome of deliberative processes.
• To establish a framework for understanding medN that is applicable to healthcare systems.
• To decouple the concept of medN from economic considerations.

Main Methods:

• Conceptual analysis of the term 'medical necessity'.
• Development of a framework based on transparent, trustworthy, and coherent deliberative procedures.
• Focus on the relational aspect of medN within healthcare systems.

Main Results:

• Medical necessity (medN) can be understood as the emergent property of robust deliberative procedures.
• This redefined medN is system-relative, focusing on the healthcare context.
• The proposed concept of medN is independent of economic valuations.

Conclusions:

• Redefining medical necessity (medN) through deliberative processes enhances its utility and clarity.
• Adopting a system-relative, economically independent view of medN supports equitable healthcare allocation.
• This approach provides a more nuanced and functional understanding of medical necessity in healthcare.