Abstract

The role of American corporations as purchasers of health insurance for their employees has changed dramatically over the past several decades from a passive stance to an aggressive purchasing and policy-making role. The transformation has caused purchasers to question the appropriateness of their health benefit interventions for legal, ethical, and financial reasons. Recent research about the role of "medical necessity" in California managed care decision making reveals a number of problems purchasers face and describes solutions recommended by some purchasers to those problems.