๐ ็ธฝ็ฎ้ ๏ฝ ๐ ่ฑๆๅๆ๏ผๆฌ็ฏ๏ผ ๏ฝ ๐ ๅฎๆด็ฟป่ญฏ ๏ฝ โญ ็ฒพ่ฏ็ญ่จ
Rationing
Rationing
Appropriate use criteria (AUC) were developed jointly by the AAD, American Society for Dermatologic Surgery, American College of Mohs Surgery, and the American Society for Mohs Surgery, and have been widely popularized and adopted.72,73
The ethics of this rationing behavior have not been exhaustively explored.74,75 Though it is tempting to accept AUC as de facto ethical guidelines, these criteria were developed with an eye to mitigating the risk of reimbursement restrictions through selfregulation. As one of the most costly treatments in dermatology, Mohs surgery has undergone significant scrutiny, and its cost effectiveness has been the subject of debate.76โ80
This touches on the issue of conflict of interest; it could also be argued, however, that there is no true conflict here at all. For the patient, Mohs surgery provides the greatest chance of tumor removal coupled with the smallest scar; for the physician, it provides the greatest reimbursement and the satisfaction of knowing that the patientโs best interests were served. What duty does the physician have to the insurer beyond a contractual relationship? While this could be framed as a justice issue, would its outcome be different if the patient were insured through a state-funded plan or an expensive private insurer? On a pragmatic level, the patientโs insurer may have a policy in place regarding reimbursement for Mohs in low-risk locations, though patient preferences remain an important consideration when determining treatment options.