Definition of ‘Medical Necessity’

by Larry Emmott on March 8, 2012

in Health Care Politics

As dental professionals we know this:

…most medical decisions do not post clear choices of life versus death, nor juxtapose complete cures against pure quackery. Rather, the daily stuff of medicine is a continuum requiring a constant weighing of uncertainties and values. One antibiotic regimen may be medically comparable to and much less expensive than another, but with slightly higher risk of damage to hearing or to organs like kidneys or liver. For a patient needing hip replacement, one prosthetic joint may be longer-lasting but far costlier than an alternative. Of two equally effective drugs for hypertension, the costlier one may be more palatable because it has fewer side effects and a convenient once-a-day dosage.

Across such choices, it is artificially precise to say that one option is “necessary” — with the usual connotation of “essential” or “indispensable” – while the other is “unnecessary” — with the usual connotation of “superfluous” or “pointless.”

via There Is No Objective Definition of ‘Medical Necessity’ – Michael F. Cannon – Townhall Finance Conservative Columnists and Financial Commentary – Page 1.

The fact is there is no one “best way” to treat our patient’s dental conditions. The ultimate treatment decision is a considered compromise between effectiveness, cost, potential hazards and alternatives. It is our job (as dental professionals) to know the options, understand the individuals and present these options in a simple manner then help patients decide. Determining “evidence based” best treatments seems so right yet the fact is that there is often not a single “best” alternative.

When these essentially individual decisions are taken away from the patient and doctor by a third party, either a payer or the government, options are reduced, the individual is subordinated to the mass and the ultimate quality of care suffers.

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