ABSTRACT
A duly constituted body or panel, composed both of physicians and non-physicians, would develop necessary-care guidelines for each preventive, diagnostic, and therapeutic intervention commonly used in the American health care system today. These guidelines would specify the clinical indications for which specified interventions shall be deemed necessary for purposes of insurance coverage. "Net health benefit" would be defined as the life-expectancy and quality-of-life improvements expected from the intervention minus any expected negative consequences, including any risk of death or of unpleasant or dangerous side effects. Guidelines would be continually updated as warranted by new evidence. Depending on how the Panel was constituted, necessary-care guidelines might have to be approved by an appropriate state entity. Moreover, plans offering the basic benefit plan would be required either to meet applicable state and federal regulations or to obtain waivers from these regulations.
