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Previous Volume 340:229-232 January 21, 1999 Number 3 Next

	Since this article has no abstract, we have provided an extract of the first 100 words of the full text and any section headings.

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In the United States there has been a radical shift in the power to determine when health care is medically necessary and therefore covered by insurance. From the 1950s through the late 1970s, physicians' medical opinions largely dictated coverage and were rarely challenged by insurers. Physicians no longer have this extraordinary level of autonomy. Insurers now routinely make treatment decisions by determining what goods and services they will pay for. The line between clinical decisions about necessary medical care and decisions about insurance coverage is particularly blurred in managed-care plans. The power of insurers to determine coverage potentially gives them . . . [Full Text of this Article]

Background

Problems with the Use of Generalized Evidence of Medical Necessity

Practical Limitations of Generalized Evidence

The Rigors of Science

The Need for National Reform

References

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