„Medizinische Notwendigkeit“: Herausforderungen eines unscharfen Begriffs

Definition of the problem: “Medical necessity” (MedN) is the central regulatory concept for decisions about which services are covered by German statutory health insurance. Despite its seeming objectivity and dependence on physicians’ expert judgment, the concept is by no means clearly defined. Arguments: In this first of five planned papers on the conceptual analysis of MedN from the perspectives of philosophy and ethics of medicine, law, and (social) medicine, the focus lies on systemizing ongoing controversies. Conclusion: Our goal is to come up with a so far missing foundation for detailed debates. We aim to clarify MedN’s conceptual structure, function, contextuality, and ambiguities as well as the fundamental limits of conceptual investigations for the normative questions at issue of regulating medical services.