Controlling Costs and Changing Patient Care?:

The Role of Utilization Management

Status: Available Now

Size: 328 pages, 6 x 9

Publication Year:1989

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Authors:
Committee on Utilization Management by Third Parties, Institute of Medicine
Authoring Organizations

Description:
Utilization management (UM) has become a strong trend in health care cost containment. Under UM, some decisions are not strictly made by the doctor and patient alone. Instead, they are now checked by a reviewer reporting to an employer or ...
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Table of Contents
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Front Matter	i-viii
Executive Summary	1-12	(skim)
Utilization Management: Introduction and Definitions	13-26	(skim)
Origins of Utilization Management	27-57	(skim)
The Utilization Management Industry: Structure and Process	58-90	(skim)
Impact of Prior Review Programs	91-118	(skim)
High-Cost Case Management	119-142	(skim)
Conclusions and Recommendations	143-162	(skim)
Acknowledgments	163-166	(skim)
Appendixes	167-168	(skim)
Appendix A - Legal Implications of Utilization Review	169-204	(skim)
Appendix B - Utilization Management and Quality Assurance in Health Maintenence Organiztions: An Operational Assesment	205-245	(skim)
Appendix C - Utilization Management in Peer Review Organizations	246-249	(skim)
Appendix D - Summary of Public Hearings	250-252	(skim)
Appendix E - Summaries of Committee Site Visits to Utilization Management Organizations	253-281	(skim)
Appendix F - Analysis of Agreements Between Utilization Management Organizations and Their Clients	282-287	(skim)
Appendix G - Glossary and Acronyms	288-292	(skim)
Appendix H - Biographies of Committee Members	293-300	(skim)
Index	301-312	(skim)

Description

Utilization management (UM) has become a strong trend in health care cost containment. Under UM, some decisions are not strictly made by the doctor and patient alone. Instead, they are now checked by a reviewer reporting to an employer or other paying party who asks whether or not the proposed type or location of care is medically necessary or appropriate.
This book presents current findings about how UM is faring in practice and how it compares with other cost containment approaches, with recommendations for improving UM program administration and clinical protocols and for conducting further research.

Authoring Organizations

Institute of Medicine (IOM)

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