Utilization management as a cost-containment strategy.
Bailit, Howard L
Date of Pub
Utilization management (UM) is now an integral part of most public and private health plans. Hospital review, until recently
the primary focus of UM, is associated with a reduction in bed days and rate of hospital cost increases. These reductions
appear to have had limited impact on aggregate health care costs because of increases in unmanaged services. In the future,
with electronic connectivity between payers and providers and the use of clinical guidelines and computer-based decision-support
systems, the need for prospective case-level reviews will be reduced. With these changes, UM programs are likely to become
more acceptable to providers and patients.
Cost Control/methods : Evaluation Studies : Forecasting : Hospitals/utilization : Insurance Claim Review/trends : Insurance,
Hospitalization/utilization : Medicare/utilization : Professional Review Organizations : Quality of Health Care : United States
: Utilization Review/methods/trends