Keywords
Patient outcomes
Cost control
Clinical pathways
Care standards
Submitted : 2024-08-28
Accepted : 2024-09-12
Published : 2024-09-27
Abstract
Utilization management plays a crucial role in healthcare by optimizing resource allocation, improving patient outcomes, and effectively controlling costs. By balancing patient needs with economic considerations, healthcare institutions can ensure efficient and sustainable service delivery. Utilization management encompasses various strategies, including prior authorization, concurrent review, and clinical pathways, to enhance care quality, manage expenses, and streamline resource use. The benefits of utilization management include cost containment, improved care standards, and the implementation of consistent treatment guidelines, thereby increasing the overall efficiency and effectiveness of healthcare delivery.
References
Ginter PM, Duncan WJ, Swayne LE, 2018, The Strategic Management of Health Care Organizations (8th Edition). John Wiley & Sons, Inc., Hoboken (NJ).
Bose R, 2003, Knowledge Management-Enabled Health Care Management Systems: Capabilities, Infrastructure, and Decision-Support. Expert Systems with Applications, 24(1): 59–71. https://doi.org/10.1016/S0957-4174(02)00083-0
Nelson MF, Christenson RH, 1995, The Focused Review Process: A Utilization Management Firm’s Experience with Length of Stay Guidelines. Joint Commission Journal on Quality Improvement, 21(9): 477–487.
Poynter WL, Textbook of Behavioural Managed Care: From Concept through Management to Treatment (1st Edition). Routledge, New York. https://doi.org/10.4324/9780203777831
Stahl MJ, 2003, Encyclopedia of Health Care Management. Sage Publications, Inc., Thousand Oaks (CA).
Wickizer TM, Lessler D, 2002, Utilization Management: Issues, Effects, and Future Prospects. Annu Rev Public Health, 23: 233–254. https://doi.org/10.1146/annurev.publhealth.23.100901.140529
Huck A, Lewandrowski K, 2014, Utilization Management in the Clinical Laboratory: An Introduction and Overview of the Literature. Clin Chim Acta, 427: 111–117. https://doi.org/10.1016/j.cca.2013.09.021
Plebani M, Zaninotto M, Faggian D, 2014, Utilization Management: A European Perspective. Clin Chim Acta, 427: 137–141. https://doi.org/10.1016/j.cca.2013.03.002
Koike A, Klap R, Unützer J, 2000, Utilization Management in A Large Managed Behavioral Health Organization. Psychiatr Serv, 51(5): 621–626. https://doi.org/10.1176/appi.ps.51.5.621
Field MJ, Gray BH, 1989, Should We Regulate ‘Utilization Management?’. Health Aff (Millwood), 8(4): 103–112. https://doi.org/10.1377/hlthaff.8.4.103
Carlsson L, Berkes F, 2005, Co-Management: Concepts and Methodological Implications. Journal of Environmental Management, 75: 65–76. https://doi.org/10.1016/j.jenvman.2004.11.008
Randall VR, 1993, Managed Care, Utilization Review, and Financial Risk Shifting: Compensating Patients for Health Care Cost Containment Injuries. University of Puget Sound Law Review, 17(1): 1–86.
Baron JM, Dighe AS, 2014, The Role of Informatics and Decision Support in Utilization Management. Clin Chim Acta, 427: 196–201. https://doi.org/10.1016/j.cca.2013.09.027