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March 22, 1995

Essential vs Discretionary Health Care in System Reform

Author Affiliations

University of Virginia Medical Center Charlottesville

JAMA. 1995;273(12):918-919. doi:10.1001/jama.1995.03520360032026

To the Editor.  —The Council on Ethical and Judicial Affairs of the American Medical Association proposed an inadequate approach for assuring "the provision of adequate health care" in its report on ethical issues in health care system reform.1 The Council recognizes that a "strong subjective element [is] inherent in choosing what health care services are essential." The Council's alternative approaches for assuring an adequate health care program, a "democratic process" to define benefit packages, or "an equal consideration mechanism or random selection," assume a bureaucratic process is required to identify the package of health services for all citizens. It identifies a minor role for physicians in these resource allocation decisions that are unique for each individual.Society, through government for publicly funded programs and insurers for privately funded programs, provides beneficiaries assurance of payment for medical services. These insurance programs treat all services as either covered or not covered,

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