Reduction Mammaplasty: Defining Medical Necessity

Carolyn L. Kerrigan, E. Dale Collins, H. Myra Kim, Paul L. Schnur, Edwin Wilkins, Bruce Cunningham and Julie Lowery
Additional contact information
Carolyn L. Kerrigan: Section of Plastic Surgery, Dartmouth-Hitchcock Medical Center and Dartmouth Medical School, Lebanon, New Hampshire, Arizona
E. Dale Collins: Section of Plastic Surgery, Dartmouth-Hitchcock Medical Center and Dartmouth Medical School, Lebanon, New Hampshire, Arizona
H. Myra Kim: Center for Statistical Consultation and Research, Arizona
Paul L. Schnur: Division of Plastic and Reconstructive Surgery, Mayo Clinic, Scottsdale, Arizona
Edwin Wilkins: Section of Plastic Surgery, University of Michigan Health System, Arizona
Bruce Cunningham: University of Michigan, Ann Arbor; the Division of Plastic Surgery, University of Minnesota, Minneapolis, Arizona
Julie Lowery: Veterans Affairs Center for Practice Management and Outcomes Research, Arizona

Medical Decision Making, 2002, vol. 22, issue 3, 208-217

Abstract: The authors evaluated existing and new criteria for defining the medical necessity for breast reduction surgery. Two cohorts of women (those requesting breast reduction surgery [ N = 266] and a group of controls [ N = 184]) completed a questionnaire including breast-specific symptom severity, the Short Form 36, the EuroQol, the McGill Pain Questionnaire, and the Multidimensional Body Self Relations Questionnaire. To evaluate prediction validity, the most widely accepted decision criteria and a new definition of medical necessity were applied to the data set to determine whether women meeting the definition had more favorable outcomes than those who did not as measured by validated self-report instruments. For existing criteria, women not meeting and meeting the criterion gained equal benefit from surgery. Women meeting the new definition (2 of 7 physical symptoms all or most of the time) had significantly greater improvement scores on 4 of the 5 health burden measures compared to women not meeting this definition. The authors conclude that medical necessity for breast reduction surgery is better defined by self-report of symptoms than by existing criteria.

Keywords: breast; mammaplasty; health care rationing; patient selection; eligibility determination; insurance coverage (search for similar items in EconPapers)
Date: 2002
References: View references in EconPapers View complete reference list from CitEc
Citations:

Downloads: (external link)
https://journals.sagepub.com/doi/10.1177/0272989X0202200309 (text/html)

Related works:
This item may be available elsewhere in EconPapers: Search for items with the same title.

Export reference: BibTeX RIS (EndNote, ProCite, RefMan) HTML/Text

Persistent link: https://EconPapers.repec.org/RePEc:sae:medema:v:22:y:2002:i:3:p:208-217

DOI: 10.1177/0272989X0202200309

Access Statistics for this article

More articles in Medical Decision Making
Bibliographic data for series maintained by SAGE Publications ().