What care should be covered?

Kennedy Institute of Ethics Journal 7 (4):331-336 (1997)
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Abstract

: The answer to the question of what health care services should be covered by a managed care plan is straightforward; the plan should cover whatever the consumer is willing to pay for. From the plan's perspective, the consumer is the payer, that is, the employer who negotiates the plan; not the individual patient whose personal preferences and interests may be quite different. Since managed care organizations contract with payers to arrange for health care services within a defined set of benefits, there is a broader question as well: Within the benefits chosen by the payer, what actually is covered? Criteria for determining "medical necessity," which managed care plans frequently use as the basis for coverage, are discussed

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The Concept of Underinsurance: A General Typology.Andrew Ward - 2006 - Journal of Medicine and Philosophy 31 (5):499 – 531.

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