Impact of Private Utilization Review on Hospital Use and Medical Care Expenditures among Insured Groups. Executive Summary

摘要

The purpose of this study was to determine the effects of a utilization review (UR) on hospital use and medical expenditures. The study used a (means-difference) covariance model to estimate the effects of UR, based on analysis of pooled data representing the claims experience of 223 privately insured groups for the period 1984 through 1986. It found that UR had a significant negative effect on the utilization and expenditures of insured groups. UR reduced admissions by 12.2 percent (p