Utilization review, DRGs, and physician autonomy

Utilization review and the current Medicare prospective payment system are part of a continuum of Federal legislation aimed at controlling scarce health care resources. Physicians have met these attempts to establish standards of utilization and fiscal control with varying levels of cooperation and resistance. This paper examines the physician's perceived threat to professional practice that these allocation strategies represent. The paper addresses four major areas of concern: bureaucratic tensions; income; clinical decision-making; and self-regulation. The paper ends by discussing the benefits for physicians in taking a proactive stance toward these measures.