MEDICAL NECESSITY IN CANADIAN HEALTH-POLICY - 4 MEANINGS AND ... A FUNERAL

Four meanings of medical necessity have emerged, evolved, and dominate d past and current health policy debates about the appropriate level o f service coverage under Canada's health insurance program. To explore the shift in definition, provincial government and national health ca re association position papers responding to federal legislative and p olicy reviews of Canada's health insurance program from 1957 to 1984 w ere examined, as were more current reports on medical necessity. Four meanings of medical necessity predominated: ''what doctors and hospita ls do''; ''the maximum we can afford''; ''what is scientifically justi fied''; and ''what is consistently funded across all provinces.'' Thes e meanings changed with time as different stakeholder associations and governments redefined the concept of medical necessity to achieve dif ferent policy objectives for health service coverage under Canada's he alth insurance program.