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September 1997 (Volume 75)
Victoria A. Vincent
Milbank Memorial Fund
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Four meanings of medical necessity have emerged, evolved, and dominated past and current health policy debates about the appropriate level of service coverage under Canada’s health insurance program. To explore the shift in definition, provincial government and national health care association position papers responding to federal legislative and policy reviews of Canada’s health insurance program from 1957 to 1984 were examined, as were more current reports on medical necessity. Four meanings of medical necessity predominated: “what doctors and hospitals do”; “the maximum we can afford”; “what is scientifically justified”; and “what is consistently funded across all provinces.” These meanings changed with time as different stakeholder associations and governments redefined the concept of medical necessity to achieve different policy objectives for health service coverage under Canada’s health insurance program.
Author(s): Cathy Charles; Jonathan Lomas; Mita Giacomini; Vandna Bhatia; Victoria A. Vincent
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Volume 75, Issue 3 (pages 365–394) DOI: 10.1111/1468-0009.00060 Published in 1997
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The Milbank Quarterly’s multidisciplinary approach and commitment to applying the best empirical research to practical policymaking offers in-depth assessments of the social, economic, historical, legal, and ethical dimensions of health and health care policy.