In functional medicine, the distinction between elective care and medically necessary care lies in the purpose and urgency of the treatment. Medically necessary care addresses immediate health concerns or conditions that significantly impact your daily life, such as chronic pain, autoimmune disorders, or metabolic imbalances. These interventions are crucial for restoring baseline health and preventing further complications. In contrast, elective care focuses on optimizing overall wellness, enhancing the quality of life, or addressing non-urgent health goals, such as improving athletic performance, achieving hormonal balance, or supporting long-term vitality. While both types of care play important roles, medically necessary care aims to stabilize or resolve critical issues, while elective care takes a proactive approach to help you thrive and reach your personal health potential. Both are integral to the functional medicine model, working together to address immediate needs and foster long-term well-being.
Elective Healthcare
Elective procedures or treatments are those that are planned in advance and not immediately necessary to protect or maintain life or essential health functions.
Characteristics:
• Non-urgent, scheduled at the patient’s or provider’s convenience.
• Often enhances quality of life rather than addresses life-threatening conditions.
• Includes both cosmetic and functional procedures.
Examples:
• Cosmetic surgeries (e.g., rhinoplasty, breast augmentation).
• Orthopedic surgeries (e.g., joint replacements, ACL reconstruction).
• Preventive care (e.g., colonoscopy, cataract removal).
• Fertility treatments.
Medically Necessary Healthcare
Medically necessary care addresses conditions that, if untreated, could result in serious health risks, worsening of conditions, or death.
Characteristics:
• Essential for maintaining or restoring health.
• Often urgent or required to prevent serious complications.
• Typically covered by health insurance.
Examples:
• Life-saving surgeries (e.g., heart bypass, tumor removal).
• Chronic disease management (e.g., diabetes, hypertension).
• Emergency care (e.g., for stroke, trauma, or severe infections).
• Treatments for severe mental health conditions.
Overlap and Considerations
Some treatments can fall into both categories depending on context. For example, bariatric surgery could be elective for weight loss but medically necessary for someone with severe obesity-related complications. Similarly, timing and patient health status can influence classification.
At Arete, the distinction between elective and medically necessary care might influence how we approach patient onboarding, care plans, and communication strategies, especially given our primary focus on proactive wellness and optimal health.