Final answer:
In healthcare systems, reimbursement conditions often require services to be medically necessary and skilled. This is to ensure effective and essential healthcare provision and to manage resource allocation efficiently within fee-for-service and HMO models.
Step-by-step explanation:
The conditions that often must be satisfied to justify reimbursement in healthcare systems include the services being medically necessary and skilled. This means that healthcare providers are required to provide treatments that are essential for the patient's health and must possess the professional skills necessary to deliver those treatments effectively. These criteria are particularly important in fee-for-service systems where providers are reimbursed for each service rendered, potentially creating an incentive to offer more services that may not be essential. Under alternative models, such as health maintenance organizations (HMOs), payment structures are based on patient numbers rather than services, leading to different resource allocation challenges. Reimbursement criteria are also a countermeasure to adverse selection in insurance markets, ensuring that only appropriate and necessary services are covered and provided.