Difference between revisions of "Heritage2001a"
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{{BibEntry | {{BibEntry | ||
|BibType=ARTICLE | |BibType=ARTICLE | ||
| − | |Author(s)=John Heritage; Elisabeth Boyd; Lawrence Kleinman; | + | |Author(s)=John Heritage; Elisabeth Boyd; Lawrence Kleinman; |
| − | |Title=Subverting criteria: | + | |Title=Subverting criteria: the role of precedent in decisions to finance surgery |
|Tag(s)=EMCA; Medical EMCA; Decision; Surgery; Precedent | |Tag(s)=EMCA; Medical EMCA; Decision; Surgery; Precedent | ||
|Key=Heritage2001a | |Key=Heritage2001a | ||
| Line 8: | Line 8: | ||
|Journal=Sociology of Health & Illness | |Journal=Sociology of Health & Illness | ||
|Volume=23 | |Volume=23 | ||
| − | |Pages= | + | |Number=5 |
| − | |URL= | + | |Pages=701–728 |
| − | |DOI= | + | |URL=https://onlinelibrary.wiley.com/doi/abs/10.1111/1467-9566.00272 |
| + | |DOI=10.1111/1467-9566.00272 | ||
|Abstract=This paper investigates prospective utilisation review for tympanostomy. In the studied procedure, a medical corporation reviews cases for third-party payers (insurance companies), and used explicit criteria to determine whether a case is appropriate for surgery. Earlier findings that inappropriate decisions to approve surgery are strongly related to previous surgeries for the same condition are investigated to trace the emergence of this theme within the review process and its consolidation into a ‘precedent’ for further surgery, notwithstanding the explicit criteria which the reviewers are mandated to enforce. The significance of previous surgeries as a factor favouring further surgery emerges at all levels of the review process, indicating a medical culture that validates precedent in medical decision making despite the absence of evidence-based findings that would support it. | |Abstract=This paper investigates prospective utilisation review for tympanostomy. In the studied procedure, a medical corporation reviews cases for third-party payers (insurance companies), and used explicit criteria to determine whether a case is appropriate for surgery. Earlier findings that inappropriate decisions to approve surgery are strongly related to previous surgeries for the same condition are investigated to trace the emergence of this theme within the review process and its consolidation into a ‘precedent’ for further surgery, notwithstanding the explicit criteria which the reviewers are mandated to enforce. The significance of previous surgeries as a factor favouring further surgery emerges at all levels of the review process, indicating a medical culture that validates precedent in medical decision making despite the absence of evidence-based findings that would support it. | ||
}} | }} | ||
Latest revision as of 12:32, 29 October 2019
| Heritage2001a | |
|---|---|
| BibType | ARTICLE |
| Key | Heritage2001a |
| Author(s) | John Heritage, Elisabeth Boyd, Lawrence Kleinman |
| Title | Subverting criteria: the role of precedent in decisions to finance surgery |
| Editor(s) | |
| Tag(s) | EMCA, Medical EMCA, Decision, Surgery, Precedent |
| Publisher | |
| Year | 2001 |
| Language | |
| City | |
| Month | |
| Journal | Sociology of Health & Illness |
| Volume | 23 |
| Number | 5 |
| Pages | 701–728 |
| URL | Link |
| DOI | 10.1111/1467-9566.00272 |
| ISBN | |
| Organization | |
| Institution | |
| School | |
| Type | |
| Edition | |
| Series | |
| Howpublished | |
| Book title | |
| Chapter | |
Abstract
This paper investigates prospective utilisation review for tympanostomy. In the studied procedure, a medical corporation reviews cases for third-party payers (insurance companies), and used explicit criteria to determine whether a case is appropriate for surgery. Earlier findings that inappropriate decisions to approve surgery are strongly related to previous surgeries for the same condition are investigated to trace the emergence of this theme within the review process and its consolidation into a ‘precedent’ for further surgery, notwithstanding the explicit criteria which the reviewers are mandated to enforce. The significance of previous surgeries as a factor favouring further surgery emerges at all levels of the review process, indicating a medical culture that validates precedent in medical decision making despite the absence of evidence-based findings that would support it.
Notes
