Medical necessity and psychotherapy

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.