Medical Necessity in the Contexts of Patient Care, Health Politics, and Setting Limits to Health Services. An Analysis in Medical Philosphy, Health Ethics, and Social Law.
Final Report Abstract
The central question of this project aimed at the suitability and problematic nature of the concept of medical necessity (MedN) for its intended role as a regulating concept in health care. The main idea of this interdisciplinary project was to examine the medically, ethically and legally underdefined concept of medN deploying three perspectives. Its aim was to arrive at a common definition of medN. We were able to show, that the concept of medN is used and understood differently within and between contexts, combines normative and descriptive elements in a way that has not yet been systematically clarified, is thus, philosophically speaking, a "thick concept" and has so far been opaque regarding the nature and genesis of implicit value judgements. We wanted to remedy these deficiencies in this project. Central questions were those concerning: • the outlines of the different uses of the notion of medN; • the interplay of descriptive and normative conceptual elements; • the plausibility of a uniform ideal-typical medN concept; • the pragmatic and normative advantages and dangers of a regulative concept of medN. With these questions raised, we methodically developed a three-step approach, which is reflected in the publication strategy of the project group. The first step consisted of "mapping the conceptual field of medN", which we carried out on the conceptual level as well as on the contextual level. In the second step, we examined the three factors whose joint evaluation and mutual reference lead to the necessity judgements in question: i) conditions of disease; ii) medical goals; iii) medical methods. We wanted to move "in front of the statutory health insurance" (SHI; German: GKV) and develop the key data for an audit programme with the help of which the SHI should assess medical methods – both already financed methods and newly 'intruding' ones. In doing so, the tools of our three disciplines should be used to investigate which parameters need to be considered without being limited by the narrow view of SHI law.
Publications
- 2018. „Medizinische Notwendigkeit“: Herausforderungen eines unscharfen Begriffs. Ethik in der Medizin: 1–17
Schöne-Seifert, Bettina, Daniel R. Friedrich, Anke Harney, Stefan Huster, and Heiner Raspe
(See online at https://doi.org/10.1007/s00481-018-0497-5) - 2019. Medizinische Behandlungsmethoden: Was macht sie medizinisch notwendig? Teil I: Medizinische Methoden, medizinische Notwendigkeit und ihre Hauptkriterien. Das Gesundheitswesen
Raspe, Heiner, Daniel R. Friedrich, Anke Harney, Stefan Huster, and Bettina Schoene-Seifert
(See online at https://doi.org/10.1055/a-0965-6866) - 2019. Medizinische Behandlungsmethoden: Was macht sie medizinisch notwendig? Teil II: Weitere Kriterien, Übermaßverbot, wandernde Grenzen und Grauzonen. Das Gesundheitswesen
Raspe, Heiner, Daniel R. Friedrich, Anke Harney, Stefan Huster, and Bettina Schoene-Seifert
(See online at https://doi.org/10.1055/a-0965-6748)
