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4 Health L.J. 63 (1996)
Wishful Thinking: Defining Medically Necessary in Canada

handle is hein.journals/hthlj4 and id is 69 raw text is: Wishful Thinking: Defining Medically Nescessary in Canada Timothy A. Caulfield A. Introduction Intuitively, it seems logical to restrict access to publically funded health care to those services which have been established as truly necessary. Why should the public be called upon to pay for frivolous or marginally effective health care - particularly in this era of fiscal restraint? Unfortunately, the complex problem of cost containment in health care will not yield to such obvious solutions. This paper will examine both the difficulties associated with attempting to define medically necessary and why the use of this simplistic approach is likely to fail as an equitable mechanism of health reform. I will begin with a brief review and critique of the rationale for seeking a definition of this term. This will be followed by a discussion and analysis of the various approaches and mechanisms used to define or operationalize medically necessary. Finally, some preliminary recommendations and conclusions are provided. B. Analysis of the Rationale for Defining Medically Necessary While -medically necessary1 is far from a new concept, the desire to find an operational definition has never been stronger. Driven by the need, perceived or otherwise, to restrict the growth of provincial health care budgets, medically Timothy A. Caulfield, Research Director, Assistant Professor (Trust), Health Law Institute, Faculty of Law University of Alberta, Edmonton, Alberta. I would like to thank Nina Hawkins, Silvia Yee and the entire Alberta Response Team for their helful comments and suggestions. It should be noted that research for this paper was completed in the fall of 1995. Numerous similar terms are used almost interchangeably in health policy debate, such as basic services, core services and adequate care. While one could argue that there are subtle differences between these terms, this paper will largely use medically necessary as this is the term most often associated with the obligations which flow from the Canada Health Act. For a discussion of the various terms used in health legislation and debate see D. Walters and D. Morgan, Core and Comprehensive Health Care Services: 2. Quality-of-Care Issues (1995) 152 C.M.A.J. 1199 at 1200.

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