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Identifying and managing inappropriate hospital utilization: a policy synthesis
1Health Care Research Unit, Boston University School of Medicine, MA 02118.
Health Services Research
|December 1, 1987
Summary
Utilization review and utilization management are key strategies for controlling hospital costs. Understanding their development and application can improve healthcare efficiency and effectiveness for providers and payers.
Area of Science:
- Health Services Research
- Healthcare Management
- Health Economics
Background:
- Utilization review (UR) and utilization management (UM) are underutilized strategies for containing hospital costs.
- These methods involve assessing and influencing the appropriateness and efficiency of hospital care delivery.
Purpose of the Study:
- To increase awareness of UR and UM among healthcare stakeholders.
- To provide a comprehensive understanding of UR and UM concepts, history, and applications.
Main Methods:
- Synthesis of existing literature on UR and UM.
- Historical tracing of UR from unstructured to structured methods.
- Analysis of concepts and tools for assessing hospital use efficiency.
Main Results:
- Describes the scope and potential of UR and UM.
- Identifies the extent of inappropriate hospital utilization and associated factors.
- Discusses implications for designing and evaluating UR/UM programs.
Conclusions:
- UR and UM are valuable tools for cost containment in healthcare.
- Effective implementation requires understanding historical development and current applications.
- Targeted UR and UM programs can enhance healthcare efficiency and provider performance.