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Related Experiment Videos

Hospital utilization review: past experience, future directions.

D Ermann

    Journal of Health Politics, Policy and Law
    |January 1, 1988
    PubMed
    Summary

    Utilization review (UR) programs ensure medical necessity and appropriate care intensity/cost. This paper examines UR evolution, current use across payers, cost impacts, and future trends in healthcare cost and quality.

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    Area of Science:

    • Healthcare Management
    • Health Services Research
    • Medical Economics

    Background:

    • Utilization review (UR) programs have existed for over 40 years.
    • Significant evolution in UR practices has occurred in the last two decades.
    • UR is increasingly considered a tool for addressing hospital inpatient cost and quality issues.

    Purpose of the Study:

    • To analyze the historical evolution of utilization review.
    • To describe the current application of UR across various healthcare delivery mechanisms.
    • To evaluate the cost-effectiveness of different UR strategies and predict future utilization.

    Main Methods:

    • Review of historical data and literature on utilization review programs.
    • Analysis of UR implementation across diverse healthcare payers including Medicare, HMOs, PPOs, Blue Cross, and commercial insurers.
    • Examination of cost data associated with various UR approaches.

    Main Results:

    • UR programs have adapted significantly over time to meet evolving healthcare demands.
    • Current UR practices vary across different healthcare delivery systems.
    • The cost effects of UR approaches are diverse and depend on the specific methodology employed.

    Conclusions:

    • Utilization review remains a critical component of healthcare management.
    • Understanding the evolution and current application of UR is essential for optimizing healthcare costs and quality.
    • Future trends suggest continued adaptation and integration of UR strategies within healthcare systems.

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