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Related Experiment Videos

Utilization management: issues, effects, and future prospects.

Thomas M Wickizer1, Daniel Lessler

  • 1Department of Health Services, School of Public Health and Community Medicine, University of Washington, Seattle, Washington 98195-7660, USA. tomwick@u.washington.edu

Annual Review of Public Health
|March 23, 2002
PubMed
Summary
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Utilization management (UM) aims to control healthcare costs by influencing service use. This review examines UM methods like prospective review, case management, and gatekeeping, exploring their impact and future role.

Area of Science:

  • Health Services Research
  • Healthcare Administration
  • Health Economics

Background:

  • Utilization management (UM) is a prevalent cost-containment strategy in healthcare.
  • UM faces criticism from physicians regarding clinical autonomy and administrative burden.
  • Payers advocate for UM as essential for reducing unnecessary healthcare services.

Purpose of the Study:

  • To review the operation and effects of key utilization management procedures.
  • To explore the future role of utilization management in healthcare systems.
  • To propose guiding principles for future UM strategy development.

Main Methods:

  • Examination of prospective utilization review.
  • Analysis of case management programs.

Related Experiment Videos

  • Evaluation of physician gatekeeping programs.

    • Main Results:

    • UM strategies aim to influence healthcare service utilization.
    • Physician autonomy and administrative burden are key concerns.
    • UM is defended as necessary for controlling healthcare costs.

    Conclusions:

    • UM strategies significantly impact healthcare resource consumption.
    • Balancing cost containment with clinical practice is crucial.
    • Principles are needed to guide future UM development for effectiveness and acceptance.