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Controlling Costs and Changing Patient Care
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With great speed and relatively little public awareness, a significant change has occurred in the way some decisions are made about a patient's medical care. Decisions that were once the exclusive province of the doctor and patient now may be examined in advance by an external reviewer—someone accountable to an employer, insurer, health maintenance organization (HMO), or other entity responsible for all or most of the cost of the care. Depending upon the circumstances, this outside party may be involved in discussions about where care will occur, how treatment will be provided, and even whether some treatments are appropriate at all. Such "utilization management" is part of a complex balancing act created by society's struggles with two important questions. First, how do we ensure that people get needed medical care without spending so much that we compromise other important social objectives? Second, how do we discourage unnecessary and inappropriate medical services without jeopardizing necessary high-quality care?
0-309-54309-6
NONE
Management
English
1989
1-321
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