Rethinking Utilization Review

Abstract

Utilization review has become a ubiquitous component of efforts to limit the costs of medical care in the United States. This monitoring process encompasses a broad, heterogeneous group of interventions, most commonly involving the prospective review of decisions to admit patients to the hospital and perform certain procedures, but also including concurrent evaluation of inpatient care and of the management of high-cost cases. Utilization review is often performed by a third party, which may be a company operating for profit, but it can also be done internally by insurers or health plans. In 1984, this process affected the health insurance . . .