The medical model is often referred to as “medically necessary” care and/or due to “injury or sickness”. Another term being used in the medical model is “complex but stable medical condition.”
This indicates a need requiring 24 hour a day nursing observation, or professional nursing intervention more than once a day, in a setting other than the acute care unit of a hospital, which is medically necessary.
Also required is that the observation or intervention has been prescribed by a physician and it is not designed primarily for the convenience of the insured or the insured’s family.
This seems to take vagueness out of the other two terms.
Historically this was the most common benefit trigger language in nursing home and long-term care insurance but as the insurance and health care industry began to better understand the long-term care environment:
- Acute Care: short-term restorative in nature
- Chronic Care: long-term debilitating in nature where care is designed to provide maintenance and/or supportive in services
The medical model alone would not objectively measure one’s true disability.
Remember the medical model is grounded in Acute care (i.e.–short-term, restorative in nature) which is traditionally provided for by private insurance or Medicare.
