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Related Experiment Videos

Medicaid utilization control programs: results of a 1987 study.

P A Lindsey

    Health Care Financing Review
    |February 3, 1990
    PubMed
    Summary

    Medicaid agencies utilize second surgical opinion programs (SSOPs) and preadmission reviews to manage healthcare costs. This study surveyed 44 states on their use of these utilization control programs.

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    Area of Science:

    • Health Services Research
    • Public Health Policy
    • Healthcare Management

    Background:

    • Medicaid programs aim to control service utilization and expenditures.
    • Second Surgical Opinion Programs (SSOPs) and inpatient preadmission reviews are key utilization management tools.

    Purpose of the Study:

    • To report on the implementation and scope of SSOPs and inpatient preadmission review programs within State Medicaid agencies.
    • To understand the prevalence of mandatory versus voluntary SSOPs.

    Main Methods:

    • Survey research methodology.
    • Data collection from 44 State Medicaid agencies.
    • Analysis of program types: mandatory SSOPs, voluntary SSOPs, and inpatient preadmission reviews.

    Main Results:

    • The study examined 13 mandatory and 7 voluntary SSOPs.
    • Twenty-one inpatient preadmission review programs were analyzed.
    • Responses were received from 44 State Medicaid agencies.

    Conclusions:

    • Medicaid agencies actively employ SSOPs and preadmission reviews for cost containment.
    • The findings provide insights into the diverse adoption of these utilization control strategies across states.

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