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• Can anything be learned from government oversight of PROs or the accreditation process managed by the Joint Commission on the Accreditation of Health Care Organizations?

These are not simple questions. Answering them demands more information and more thoughtful debate over how to judge the strengths and weaknesses of utilization management versus those of other strategies to control costs and influence patient care decisions. This, in turn, will depend on better evidence about the impacts of different cost containment strategies. Finally, recommendations about oversight will require more deliberation about the legitimate but sometimes conflicting needs, interests, and values of the parties involved in utilization management.

In a broader sense, the limits of utilization management and any other single strategy, even any combination of strategies, need to be recognized. The issue is not whether utilization management does everything that needs to be done but whether it produces desirable results in reasonable ways at an acceptable cost. Is it, on balance, better to use it than to discard it? How can it be improved, and what other strategies are needed to supplement it? This report provides a progress report and some preliminary views on these issues.

The Institute of Medicine will continue its efforts to better define what role utilization management might play in helping society find an acceptable balance of efficiency, access, and appropriateness in health care. This clearly must be a shared venture. Fortunately, the quest to know what is useful and how to apply it universally are now central issues in medical research and public policy.



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