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Controlling Costs and Changing Patient Care?: The Role of Utilization Management
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The past decade has seen great growth in efforts by purchasers of health care to understand and influence the treatment of patients. In large measure, these efforts reflect purchasers' concerns that their increasing expenditures are not matched by increasing value and even that a significant amount of care is inappropriate and wasteful. Clinicians and researchers, too, are acutely concerned about unexplained variations in practice patterns and lack of evidence of treatment effectiveness. To respond to these concerns, we must focus on how the health care system works as well as how individual patients are served. Utilization management brings patient-level and system-level concerns together and represents a new nexus of relations among payers, practitioners, hospitals, and patients. Because it is new, at least as broadly applied, and because it is changing rapidly, utilization management needs to be watched. This report is a preliminary effort in that direction, and the committee hopes that it will inform private and public policymakers alike. Whether the current organizational forms of utilization management remain or subside, the function of managing utilization will remain a central challenge. Therefore, this committee's conclusions and recommendations bear both on generic issues of knowledge and values and on issues specific to current organizations and procedures for influencing patient care decisions.
National Academies - Organizational Body
0-309-54309-6
NONE
Management
English
1989
1-321
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