Medical technology assessment and practice guidelines: Their day in court

G. F. Anderson, M. A. Hall, E. P. Steinberg

Research output: Contribution to journalReview articlepeer-review

Abstract

There is the expectation that outcomes research and the promulgation of medical practice guidelines will be able to identify and hopefully reduce the amount of unnecessary or inappropriate medical care through a variety of methods, including utilization review. However, past efforts by public and private insurers to deny claims on the basis of formal technology assessments or practice guidelines have frequently been overturned by the courts for multifarious reasons. This paper examines the court's reluctance to accept a variety of technology assessment methods in coverage policy decisions. The paper reviews the options that have been proposed to restrict judicial involvement in the formulation of coverage policy and then proposes a new option that employs a more precise taxonomy of medical practice assessment.

Original languageEnglish (US)
Pages (from-to)1635-1639
Number of pages5
JournalAmerican journal of public health
Volume83
Issue number11
DOIs
StatePublished - 1993

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

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