Weaving Necessity: Contextualisation Practices for Achieving Robust Health Care Coverage Decisions

All health care technologies covered through the basic benefits basket of the Dutch collective health insurance should be effective, provide value for money, and be necessary. The Dutch Health Care Institute uses these criteria to advise the Minister of Health about the contents of the benefits basket. But how to establish whether a health care technology is necessary?

Turns out, there are many arguments pertaining to necessity. In various case studies from abroad and at home, including very expensive medicines, paracetamol tablets and maternity care, Tineke Kleinhout-Vliek investigated the patterned but varying use of such arguments.

Varying use of necessity argumentations may seem problematic, as variation would indicate inconsistency and potential inequity between decisions. Instead, Kleinhout-Vliek shows that these variable necessity argumentations are used for delivering tailor-made decisions, to give the decision the right context. As the relevant context differs per health care technology appraised, the relevant necessity argumentations vary likewise. Well-contextualised health care coverage decisions contain necessity argumentations that are specific for this decision and are carefully woven together, which makes the decision able to withstand pressure from outside relatively well.