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Updated: Aug 3, 2026

Using Visual and Narrative Methods to Achieve Fair Process in Clinical Care
Published on: February 16, 2011
Utilization review: theory, practice, and issues
1Florida Mental Health Institute, Tampa 33612.
Abstract:
Utilization review is now carried out by most hospitals and many health care agencies, government-sponsored local agencies, third-party payers, and private companies, yet few practical explanations of the process are available. In this guide, the author differentiates between internal and external review and their likely outcomes, outlines the development of a utilization review system, and describes the stages and levels of review. Psychiatric utilization review is especially difficult to carry out; thus it rarely goes beyond evaluating need for hospitalization and length of stay. Utilization review in general still must deal with issues related to confidentiality, the clinical responsibility of the reviewer, and whether certification for admission can reward poor or inappropriate care.
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