Medical Necessity

Health Care Access and the Politics of Decision Making

2019
•
Author:

Daniel Skinner

How the politics of “medical necessity” complicates American health care

From medical marijuana to mental health to reproductive politics, the concept of medical necessity underscores many divisive and contentious debates in American health care. Daniel Skinner constructs a comprehensive understanding of the politics of defining this concept, arguing that sustained political engagement with medical necessity is essential to developing a health care system that meets basic public health objectives.

Medical Necessity brings high-level theoretical concepts to bear on the idea of necessity, showing that this uniquely important aspect of contemporary medical administration appears and recedes in relation to a set of actors—doctors, patients, insurance companies, paraprofessionals, and lawyers—who manage the classification of treatments and negotiate the technical aspects of ‘need’ within their domains.

—

Cindy Patton, editor of Rebirth of the Clinic: Places and Agents in Contemporary Health Care

The definition of medical necessity has morphed over the years, from a singular physician’s determination to a complex and dynamic political contest involving patients, medical companies, insurance companies, and government agencies. In this book, Daniel Skinner constructs a comprehensive understanding of the politics of defining this concept, arguing that sustained political engagement with medical necessity is essential to developing a health care system that meets basic public health objectives.



From medical marijuana to mental health to reproductive politics, the concept of medical necessity underscores many of the most divisive and contentious debates in American health care. Skinner’s close reading of medical necessity’s production illuminates the divides between perceptions of medical need as well as how the gatekeeper concept of medical necessity tends to frame medical objectives. He questions the wisdom of continuing to use medical necessity when thinking critically about vexing health care challenges, exploring the possibility that contracts, rights, and technology may resolve the contentious politics of medical necessity.



Skinner ultimately contends that a major shift is needed, one in which health care administrators, doctors, and patients admit that medical necessity is, at its base, a contestable political concept.

Daniel Skinner is associate professor of health policy in the Department of Social Medicine at Ohio University’s Heritage College of Osteopathic Medicine.

Medical Necessity brings high-level theoretical concepts to bear on the idea of necessity, showing that this uniquely important aspect of contemporary medical administration appears and recedes in relation to a set of actors—doctors, patients, insurance companies, paraprofessionals, and lawyers—who manage the classification of treatments and negotiate the technical aspects of ‘need’ within their domains.

—

Cindy Patton, editor of Rebirth of the Clinic: Places and Agents in Contemporary Health Care

Skinner ultimately contends that a major shift is needed, one in which health care administrators, doctors, and patients admit that medical necessity is, at its base, a contestable political concept.

—

New Books Network

A thoughtful, crisply-written analysis of the political theater of US healthcare since the expansion of access to formal health insurance in the early twentieth century.

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PoLAR: Political and Legal Anthropology Review

Contents


Introduction: A Contentious Term of Medical Decision Making


Abbreviations


1. Medical Necessity? A Definitional, Philosophical, and Historical Question


2. In the Archive: Coding for Necessity and the Necessity of Coding


3. “No Legitimate Use”: Marijuana and the Bounds of the Medical


4. Contesting the “Medical” Necessity for Mental Health


5. Reproductive Politics: The Cases of C-Section and Abortion


Conclusion: Embracing the Politics of Medical Necessity


Acknowledgments


Notes


Index