Utilization Management Can Negatively Impact Health Care Quality and Access

From 1992 to 1997, researchers at the University of Washington School of Public Health and Community Medicine evaluated the effects of utilization management on health care quality and access.

Utilization management—which includes hospital pre-admission review, concurrent (continued-stay) review, outpatient review and case management—is the most widely used hospital cost-containment strategy.

In this project, investigators determined the effect of utilization management on patterns of care and then compared re-admission rates among patients whose use of hospital care was limited by utilization management with patients whose care had not been limited by utilization management.

Key Findings

  • Patients are rarely denied hospital admission outright.

  • Utilization management reduces hospital utilization, particularly for mental health patients.

  • Utilization management may have an adverse effect on the quality of care provided to some patients who may face a higher risk of early re-admission as a result of restrictions on their length of stay.