Page ii

National Academy Press • 2101 Constitution Avenue, N.W. • Washington, D.C. 20418

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.

This report has been reviewed by a group other than the authors according to procedures approved by a Report Review Committee consisting of members of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine.

The Institute of Medicine was chartered in 1970 by the National Academy of Sciences to enlist distinguished members of the appropriate professions in the examination of policy matters pertaining to the health of the public. In this, the Institute acts under both the Academy's 1863 congressional charter responsibility to be an adviser to the federal government and its own initiative in identifying issues of medical care, research, and education.

This project was supported by the John A. Hartford Foundation of New York City, Grant No. 87343-H, and the Pension and Welfare Benefits Adminstration, U.S. Department of Labor, Contract No. J-9-P-8-0067. The Honeywell Corporation provided funds for a roundtable meeting with corporate benefits managers. The views presented are those of the Institute of Medicine Committee on Utilization Management by Third Parties and are not necessarily those of the funding organizations. The Andrew W. Mellon Foundation contribution to independent Institute of Medicine funds was also used to support the project.

Library of Congress Cataloging-in-Publication Data

Institute of Medicine (U.s.). Committee on Utilization Management by
Third Parties.
Controlling costs and changing patient care? : the role of
utilization management / Institute of Medicine, Division of Health
Care Services, Committee on Utilization Management by Third Parties
; Marilyn J. Field and Bradford H. Gray, editors.
p. cm.
Includes bibliographical references.
ISBN 0-309-04048-5.—ISBN 0-309-04045-0 (pbk.)
1. Medical care—United States—Cost control. I. Field, Marilyn
Jane. II. Gray, Bradford H., 1942-. III. Title.
RA410.53.158 1989
338.4t 3362/10973—dc20                    89-39638
                                   CIP

No part of this book may be reproduced by any mechanical, photographic, or electronic process, or in the form of a phonographic recording, nor may it be stored in a retrieval system, transmitted, or otherwise copied for public or private use, without written permission from the publisher, except for the purpose of official use by the U.S. government.

Printed in the United States of America