Utilization management and the quality of care

Abstract

Utilization management is a mechanism for managing health care costs by assessing the appropriateness of care and influencing decisions about its provision to ensure the least costly but most effective treatment. Thus while primarily focused on reducing costs, utilization management also affects quality of care. The author reviews the historical development of utilization management, summarizes the review procedure, and suggests ways to enhance understanding of the effect of utilization management on quality of care.