Q1: A major health insurance company in Lagolia pays for special procedures prescribed by physicians only if the procedure is first approved as “medically necessary” by a company-appointed review panel. The rule is intended to save the company the money it might otherwise spend on medically unnecessary procedures. The company has recently announced that in order to reduce its costs, it will abandon this rule.
Which of the following, if true, provides the strongest justification for the company’s decision?
- Patients often register dissatisfaction with physicians who prescribe nothing for their ailments.
- Physicians often prescribe special procedures that are helpful but not altogether necessary for the health of the patient.
- The review process is expensive and practically always results in approval of the prescribed procedure.
- The company’s review process does not interfere with the prerogative of physicians, in cases where more than one effective procedure is available, to select the one they personally prefer.
- The number of members of the company-appointed review panel who review a given procedure depends on the cost of the procedure.
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