Medical professionalism under managed care: the pros and cons of utilization review

Health Aff (Millwood). 1997 Jan-Feb;16(1):106-24. doi: 10.1377/hlthaff.16.1.106.

Abstract

We contend that the full consequences of managed care for American medicine and health care professionals can be more fully understood if strategies for managing care are identified-in particular, strategies for the administrative oversight of professional decision making. In this paper we apply this perspective to the study of third-party utilization review, making use of a national survey of firms contracting to provide prior authorization for hospitalization in 1992. Survey data suggest that (1) existing approaches to utilization review differ greatly among review firms; (2) review practices that might improve agency and accountability seem to be overlooked by most review firms; and (3) a large number of review firms employ practices that undermine professional autonomy in seemingly inappropriate ways.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Data Collection
  • Decision Making
  • Managed Care Programs / standards*
  • Managed Care Programs / statistics & numerical data
  • Professional Autonomy*
  • United States
  • Utilization Review*