Utilization management: a European perspective

Utilization management (UM) in health care, based on the collection, assessment and monitoring of data pertaining to patient services and treatment, ultimately assures efficiency and effectiveness. The central role of laboratory services in modern medicine created the need to utilize UM programs in clinical laboratories in order to reduce costs, enhance efficiency and improve on quality for patients. Some UM programs have focused on improving efficiency by reducing the cost per test. Consolidation and networking have been proposed as opportunities to increase test volumes, thus achieving economy of scale, and a better ratio between test volumes and fulltime equivalent (FTE) staff. However, little evidence is available in the literature to demonstrate the efficiency of these models, and concern has been expressed regarding the possible increase in pre-analytical errors and the loss of efficient communication between clinicians and laboratory professionals. In Europe, we have seen an increasing emphasis on the importance of demand management strategies as the key to reducing costs and improving on quality in laboratory medicine. The cost of inappropriate requesting includes not only test consumables and reagents, but also additional consultations, treatment and investigations. A number of studies in literature describe strategies and initiatives designed to change and improve test requesting, but the following two items are mandatory for real improvement: a) the active involvement of requesting physicians and other stakeholders, including patients; and b) the use of combined interventions instead of a single strategy. Therefore, the use of approaches for demand management that considers pre-, within- and post-laboratory initiatives is on the increase in clinical laboratories throughout Europe.