Measuring the Necessity of Medical Procedures

The RAND method distinguishes between appropriateness of a procedure and its necessity: Necessity means that withholding a procedure would be deleterious to a patient's health. Whereas it is acceptable to provide appropriate care, it would be unacceptable not to provide necessary care. This paper presents data on the development of necessity ratings for six procedures using the RAND panel appropriateness method. Comparisons of appropriateness and necessity ratings indicate that necessity ratings are different from, but related to, appropriateness ratings and that the proportion of indications for which a procedure is judged necessary varies in clinically consistent ways both among and within procedures. The article concludes that necessity ratings can be used to address the underuse of care.