ABSTRACT
This chapter argues that health care needs might be defined objectively by reference to clinical practice guidelines -- provided that the guidelines are developed using an explicit standard of treatment effectiveness. These "necessary-care guidelines" could help society meet its ethical obligations by defining objectively when desired services are truly needed. Colorado residents can receive tonsillectomies or total hip replacements under Medicare only if they meet one of the depicted indications. Physicians who desire medical care for patients beyond what is normally covered by the criteria must convince a Colorado Foundation for Medical Care physician that such care is necessary. The evolution of variously stringent legal standards of proof is directly relevant to the health system and to the problem of defining health care needs. The chapter shows how the relative stringency of coverage criteria determines the range of indications covered for a specified treatment.
