Utilization review

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In health care quality assurance and financing, utilization review is "an organized procedure carried out through committees to review admissions, duration of stay, professional services furnished, and to evaluate the medical necessity of those services and promote their most efficient use."[1]

Utilization review has uncertain effectiveness.[2][3]

Financial risk sharing may lead physicians to perform utilization review.[4]

Utilization review has been accused of racketeering.[5]


  1. Anonymous (2015), Utilization review (English). Medical Subject Headings. U.S. National Library of Medicine.
  2. Rosenberg SN, Allen DR, Handte JS, Jackson TC, Leto L, Rodstein BM et al. (1995). "Effect of utilization review in a fee-for-service health insurance plan.". N Engl J Med 333 (20): 1326-30. DOI:10.1056/NEJM199511163332006. PMID 7566025. Research Blogging.
  3. Greenberg JD, Hoover DR, Sharma R, Noveck H, Bueno M, Carson JL (2004). "Reimbursement denial and reversal by health plans at a university hospital.". Am J Med 117 (9): 629-35. DOI:10.1016/j.amjmed.2004.06.025. PMID 15501199. Research Blogging.
  4. Kerr EA, Mittman BS, Hays RD, Siu AL, Leake B, Brook RH (1995). "Managed care and capitation in California: how do physicians at financial risk control their own utilization?". Ann Intern Med 123 (7): 500-4. PMID 7661493[e]
  5. Template:Err. State Groups Join Doctors in Suing Insurers - NYTimes.com, The New York Times, NYTC, Template:Err. Retrieved on August 24, 2011.

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